Rescue ALPPS is efficient and safe after failed portal vein occlusion in patients with colorectal liver metastases

Sparrelid, Ernesto; Gilg, Stefan; Brismar, Torkel B.; Lundell, Lars; Isaksson, Bengt

doi:10.1007/s00423-016-1524-y

Cited by 33 publications

(27 citation statements)

References 31 publications

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“…It was observed that such a strategy was able to achieve a more rapid and robust hypertrophy of the FLR (107). Thus, the volume of the FLR increased to more than 30% of TLV in more than 90% of patients and this hypertrophy was achieved after 7-10 days following the first stage (101,107,108). These results led to an impressive higher resectability rate, exceeding 90% (89).…”

Section: Associating Liver Partition and Portal Vein Ligation For mentioning

confidence: 65%

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Surgical Options in Synchronous Liver Metastases from Colorectal Cancer

Alexandrescu¹,

Diaconescu²,

Popescu³

2017

JTMR

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Currently, the treatment of liver metastases of colorectal cancer (CRC) requires a multidisciplinary approach and should be individualized for each patient. Liver resection provides 5 years survival rates ranging between 30 and 58% in patients with liver metastases of CRC. The optimal timing of liver resection, resection of the primary tumor and neoadjuvant chemotherapy has not been fully established, yet, neither for initially resectable synchronous liver metastases, nor for those initially unresectable which could be converted to resectability. Advocates of simultaneous resection and those of staged resection (delayed liver resection or "liver first approach"), both presented theoretical arguments in favor of each of these therapeutic strategies. Progresses in liver surgery, anesthesia, intensive care and oncology caused a paradigm shift regarding the approach of synchronous colorectal liver metastases, with simultaneous resection (SR) becoming a safer procedure in the last decade. As well, the oncologic outcomes of SR are similar to those achieved by staged resection. In this review we present the literature data concerning the results achieved by each of the currently available therapeutic approaches. Abbreviations: CLMs -colorectal liver metastases, SCLMs -synchronous colorectal liver metastases, CRC -colorectal cancer, PVL-portal vein ligation, PVE -portal vein embolization, SR -simultaneous resection, DR -delayed liver resection, SgR -staged resections, FLR -future liver remnant, CHT -chemotherapy, OS -overall survival, DFS -disease-free survival, ETS -early tumor shrinkage

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Section: Associating Liver Partition and Portal Vein Ligation For mentioning

confidence: 65%

“…This approach has been employed to overcome the disadvantages of the two previous strategies (101). This operation was performed until now almost exclusive in patients whose primary tumor has already been resected.…”

Section: Associating Liver Partition and Portal Vein Ligation For mentioning

confidence: 99%

Surgical Options in Synchronous Liver Metastases from Colorectal Cancer

Alexandrescu¹,

Diaconescu²,

Popescu³

2017

JTMR

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“…Patients with previous PVO with an insufficient response to the procedure, i.e., still with a FLR/BW of < 0.5%, were also considered eligible for inclusion in the study if they fulfilled the inclusion criteria mentioned above. Some of our patients were also included in previously published studies, one in which liver volume and function in ALPPS were assessed with a multimodal approach [12] and another evaluating only rescue ALPPS patients after failed PVO [13]. …”

Section: Methodsmentioning

confidence: 99%

“…In the patients who previously underwent embolization or ligation of the portal vein, i.e., before ALPPS, these procedures were performed as described previously [13]. …”

Section: Methodsmentioning

confidence: 99%

Serial Assessment of Growth Factors Associated with Liver Regeneration in Patients Operated with Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy

et al. 2018

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Background: There is limited knowledge about the mechanisms behind the unparalleled growth of the future liver remnant (FLR) linked to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). In this study, liver regenerative markers were examined in patients subjected to ALPPS. Methods: Ten patients with colorectal liver metastases treated with neoadjuvant chemotherapy and ALPPS were included. Plasma was sampled at 6 time points and biopsies from both liver lobes were collected at both stages of ALPPS. The levels of interleukin (IL)-6, hepatocyte growth factor (HGF), tumor necrosis factor-α, epidermal growth factor, and vascular endothelial growth factor in plasma were measured at each time point. Expression of mRNA for markers of proliferation and apoptosis was studied in the biopsies from both liver lobes taken at both stages. Results: ALPPS resulted in a peak of IL-6 after stage 1 (p = 0.004), which decreased rapidly and did not increase again after stage 2. HGF also increased after stage 1 (p = 0.048), and the HGF levels correlated significantly with the degree of growth of the FLR before stage 2 (p = 0.02, r² = 0.47). There was a correlation between peak levels of IL-6 and HGF (p = 0.03, r² = 0.84). Conclusions: IL-6 and HGF seem to be early mediators of hypertrophy after stage 1 in the ALPPS procedure. The peak HGF plasma level correlates with the degree of FLR growth in patients subjected to ALPPS.

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“…This procedure has been reported for patients with insufficient FLR hypertrophy following PVE [47,48,49]. Mean FLR hypertrophy after sequential PVE and ALPPS ranges from 57 to 65% [48,49].…”

Section: Options To Improve Future Liver Remnant Hypertrophymentioning

confidence: 99%

Portal Vein Embolization: State-of-the-Art Technique and Options to Improve Liver Hypertrophy

Huang

Aloia

2017

Visc Med

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Portal vein embolization (PVE) is associated with a high technical and clinical success rate for induction of future liver remnant hypertrophy prior to surgical resection. The degree of hypertrophy is variable and depends on multiple factors, including technical aspects of the procedure and underlying chronic liver disease. For patients with insufficient liver volume following PVE, adjunctive techniques, such as intra-portal administration of stem cells, dietary supplementation, transarterial embolization, and hepatic vein embolization, are available. Our purpose is to review the state-of-the-art technique associated with high-quality PVE and to discuss options to improve hypertrophy of the future liver remnant.

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Rescue ALPPS is efficient and safe after failed portal vein occlusion in patients with colorectal liver metastases

Cited by 33 publications

References 31 publications

Surgical Options in Synchronous Liver Metastases from Colorectal Cancer

Surgical Options in Synchronous Liver Metastases from Colorectal Cancer

Serial Assessment of Growth Factors Associated with Liver Regeneration in Patients Operated with Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy

Portal Vein Embolization: State-of-the-Art Technique and Options to Improve Liver Hypertrophy

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