Functional considerations in ALPPS – consequences for clinical management

Stockmann, Martin; Bednarsch, Jan; Malinowski, Maciej; Blüthner, Elisabeth; Pratschke, Johann; Seehofer, Daniel; Jara, Maximilian

doi:10.1016/j.hpb.2017.07.010

Cited by 11 publications

(10 citation statements)

References 31 publications

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“…In fact, the fast liver hypertrophy following ALPPS does not mean an improvement in liver function, explaining the worst perioperative results following this approach. 69 Regarding OS, ALPPS showed similar results when compared to other strategies.…”

Section: Discussionmentioning

confidence: 71%

Preoperative strategies to improve resectability for hepatocellular carcinoma: a systematic review and meta-analysis

Tustumi

Ernani

Coelho

et al. 2018

HPB

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Section: Discussionmentioning

confidence: 71%

Preoperative strategies to improve resectability for hepatocellular carcinoma: a systematic review and meta-analysis

Tustumi

Ernani

Coelho

et al. 2018

HPB

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“…Clinically, the interval time between two stages of ALPPS is usual one or two weeks. Additionally, several studies also have shown that there is a distinct delay in functional gain compared to volumetric increase in ALPPS[ 15 , 16 ]. Therefore, the functional quality of hypertrophic response derived from ALPPS procedure, not just volumetric assessment of the FLR, should be performed to time the stage II.…”

Section: Introductionmentioning

confidence: 99%

Maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model

Tong

Meng

Chen

et al. 2018

WJG

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AIMTo establish a rat model for evaluating the maturity of liver regeneration derived from associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).METHODSIn the present study, ALPPS, partial hepatecotmy (PHx), and sham rat models were established initially, which were validated by significant increase of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1. In the setting of accelerated proliferation in volume at the second and fifth day after ALPPS, the characteristics of newborn hepatocytes, as well as specific markers of progenitor hepatic cell, were identified. Afterwards, the detection of liver function followed by cluster analysis of functional gene expression were performed to evaluate the maturity.RESULTSCompared with PHx and sham groups, the proliferation of FLR was significantly higher in ALPPS group (P = 0.023 and 0.001 at second day, P = 0.034 and P < 0.001 at fifth day after stage I). Meanwhile, the increased expression of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1 verified the accelerated liver regeneration derived from ALPPS procedure. However, ALPPS-induced Sox9 positive hepatocytes significantly increased beyond the portal triad, which indicated the progenitor hepatic cell was potentially involved. And the characteristics of ALPPS-induced hepatocytes indicated the lower expression of hepatocyte nuclear factor 4 and anti-tryptase in early proliferative stage. Both suggested the immaturity of ALPPS-derived liver regeneration. Additionally, the detection of liver function and functional genes expression confirmed the immaturity of renascent hepatocytes derived in early stage of ALPPS-derived liver regeneration.CONCLUSIONOur study revealed the immaturity of ALPPS-derived proliferation in early regenerative response, which indicated that the volumetric assessment overestimated the functional proliferation. This could be convincing evidence that the stage II of ALPPS should be performed prudently in patients with marginally adequate FLR, as the ALPPS-derived proliferation in volume lags behind the functional regeneration.

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“…Twenty-seven cases of GBC infiltrating the liver parenchyma treated with ALPPS have been reported (http:// fp.amegroups.cn/cms/1395d69ef22d6ab04ec7ece0371da 2ca/hbsn-20-355-1.docx) (2,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). The most significant experiences reported came from the international ALPPS Registry studies, with five and six cases observed, respectively (21,22).…”

Section: Alpps Cases In Patients With Gbcmentioning

confidence: 99%

Uncommon indications for associating liver partition and portal vein ligation for staged hepatectomy: a systematic review

Lai¹,

Mennini²,

Laureiro³

et al. 2021

Hepatobiliary Surg Nutr

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Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) represents an innovative surgical technique used for the treatment of large hepatic lesions at high risk for post-resection liver failure due to a small future liver remnant. The most significant amount of literature concerns the use of ALPPS for the treatment of hepatocellular carcinoma (HCC), cholangiocarcinoma (CCC), and colorectal liver metastases (CRLM). On the opposite, few is known about the role of ALPPS for the treatment of uncommon liver pathologies. The objective of the present study was to evaluate the current literature on this topic. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible articles published up to February 2020 were included using the MEDLINE, Scopus, and Cochrane databases. Among the 486 articles screened, 45 papers met the inclusion criteria, with 136 described cases of ALPPS for rare indications. These 136 cases were reported in 18 different countries. Only in two countries, namely Germany and Brazil, more than ten cases were observed. As for the ALPPS indications, we reported 41 (30.1%) cases of neuroendocrine tumor (NET) metastases, followed by 27 (19.9%) cases of gallbladder cancer (GBC), nine (6.6%) pediatric cases, six (4.4%) gastrointestinal stromal tumors, six (4.4%) adult cases of benign primary liver disease, four (2.9%) adult cases of malignant primary liver disease, and 43 (31.6%) adult cases of malignant secondary liver disease.According to the International ALPPS Registry data, less than 10% of the ALPPS procedures have been performed for the treatment of uncommon liver pathologies. NET and GBC are the unique pathologies with acceptable numerosity. ALPPS for NET appears to be a safe procedure, with satisfactory long-term results. On the opposite, the results observed for the treatment of GBC are poor. However, these data should be considered with caution. The rationale for treating benign pathologies with ALPPS appears to be weak.No definitive response should be given for all the other pathologies. Multicenter studies are needed with the intent to clarify the potentially beneficial effect of ALPPS for their treatment.

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Functional considerations in ALPPS – consequences for clinical management

Cited by 11 publications

References 31 publications

Preoperative strategies to improve resectability for hepatocellular carcinoma: a systematic review and meta-analysis

Preoperative strategies to improve resectability for hepatocellular carcinoma: a systematic review and meta-analysis

Maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model

Uncommon indications for associating liver partition and portal vein ligation for staged hepatectomy: a systematic review

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