Meta-analysis of associating liver partition with portal vein ligation and portal vein occlusion for two-stage hepatectomy

Abstract

ALPPS is associated with greater future liver remnant hypertrophy and a higher rate of completion of stage 2, but this may be at the price of greater morbidity and mortality.

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

“…All these technical refinements and an improved patient selection led to a stepwise reduction of the perioperative complication rate of ALPPS [34, 35, 43, 44]. In the second large publication from the ALPPS Registry, a mortality rate of 5% for CRLM after stage 2 has been reported, which came near the reported mortality after major conventional hepatectomy [45].…”

“…With regard to the indication, subsequent reports could show that for CRLM, which is by far the most frequent indication for an ALPPS procedure, the complication rates were lower than those for primary hepatobiliary malignancies [33]. Nevertheless, complication rates after ALPPS for CRLM still seemed to be higher than after conventional liver resection, this, however, not considering a selection bias in the ALPPS group of patients with more advanced disease who otherwise would have been treated either by palliative chemotherapy alone or by extended hepatectomy after PVE and PVL [34]. …”

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in a hepatocellular carcinoma patient with inadequate remnant liver volume

“…A newly emerging technique, Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS), claims to achieve rapid liver regeneration to complete the resection in a week period [1,2].…”

ALPPS: The argument for

“…Indeed, in Schnitzbauer's original description the median hypertrophy was 74% after an interval of only nine days, and this has been confirmed by a recent meta-analysis. 7 But, we have to question if hypertrophy as seen on a CT scan will translate to adequate post resection liver function. This is an important point as there is much remaining argument about whether volumetry or functional analysis of the FLR is more important: does hypertrophy actually mean predictable improved FLR function at an early stage or should we wait longer?…”