Pushing the limit of liver regeneration – Safety and survival after monosegment-ALPPS: systematic review and individual patient data meta-analysis

Murtha-Lemekhova, Anastasia; Fuchs, Juri; Schulz, E; Sterkenburg, Anthe S.; Probst, Pascal; Hoffmann, Katrin

doi:10.1016/j.hpb.2021.06.427

Cited by 6 publications

(2 citation statements)

References 28 publications

(25 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Associating liver resection and portal vein ligation for staged hepatectomy (ALPPS) was defined for this systematic review as all kind of completed two stage hepatectomy with the first stage consisting of parenchymal transection along the definitive resection line along with ligation of the portal vein branch(es) supplying the resected segments. All variations of ALPPS, that has been first describe by Schnitzbauer et al ( 18 ), such as laparoscopic first stage or monosegment ALPPS ( 19 ) were included in our study.…”

Section: Methodsmentioning

confidence: 99%

Evidence on Indications and Techniques to Increase the Future Liver Remnant in Children Undergoing Extended Hepatectomy: A Systematic Review and Meta-Analysis of Individual Patient Data

et al. 2022

Self Cite

View full text Add to dashboard Cite

BackgroundTechniques to increase the future liver remnant (FLR) have fundamentally changed the indications and criteria of resectability in adult liver surgery. In pediatric patients however, these procedures have rarely been applied and the potential benefit or harm as well as suited indications are unclear.MethodsA systematic literature search of MEDLINE, Web of Science, and CENTRAL was conducted. Based on a PRISMA-compliant, predefined methodology, all studies reporting pediatric patients (< 18y) undergoing liver resection with either associating liver partition and portal vein ligation for stages hepatectomy (ALPPS) or preoperative portal vein embolization or ligation (PVE/PVL) were included. Baseline data, periinterventional morbidity, increase of FLR and outcomes were analyzed.Results15 studies reporting on 21 pediatric patients with a mean age of 4 years and 7 months (range 1.8 months – 17 years) were included. 12 ALPPS procedures, 8 PVE and 1 PVL were performed. The applied criteria for performing ALPPS or PVE were heterogenous and thresholds for minimally acceptable FLR varied. Mean FLR [% of total liver volume] before the intervention was 23.6% (range 15.0 – 39.3%) in the ALPPS group and 31.4% (range 21.5 – 56.0%) in the PVE group. Mean increase of FLR before stage 2 resection was 69.4% (range 19.0 – 103.8%) for ALPPS and 62.8% (range 25.0 – 108.0%) after PVE. No postoperative death occurred, one early intrahepatic recurrence after an ALPPS procedure was reported. Overall postoperative morbidity was 23.8%.ConclusionValidated criteria for minimal FLR in pediatric liver resection are lacking and so are clear indications for ALPPS or PVE. In special cases, ALPPS and PVE can be valuable techniques to achieve complete resection of pediatric liver tumors. However, more data are needed, and future studies should focus on a definition and validation of posthepatectomy liver failure as well as the minimally needed FLR in pediatric patients undergoing extended hepatectomy.Systematic Review Registration[www.clinicaltrials.gov], identifier [PROSPERO 2021 CRD42021274848].

show abstract

Section: Methodsmentioning

confidence: 99%

Evidence on Indications and Techniques to Increase the Future Liver Remnant in Children Undergoing Extended Hepatectomy: A Systematic Review and Meta-Analysis of Individual Patient Data

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…As ALPPS has facilitated surgery in otherwise incurable patients, many indications and modifications have emerged (2)(3)(4). With this, a strong heterogeneity of reports has appeared, describing low individual caseloads and mortality rates reaching up to 50% (5).…”

mentioning

confidence: 99%