Should ALPPS be Used for Liver Resection in Intermediate-Stage HCC?

D’Haese, Jan; Neumann, Jens; Weniger, Maximilian; Pratschke, Sebastian; Björnsson, Bergþór; Ardiles, Victoria; Chapman, William C.; Hernandez‐Alejandro, Roberto; Soubrane, O.; Robles, R; Stojanović, Miroslav; Valle, Raffaele Dalla; Chan, Albert; Coenen, Michaela; Guba, Markus; Werner, Jens; Schadde, Erik; Angele, Martin K.

doi:10.1245/s10434-015-5007-0

Cited by 84 publications

(91 citation statements)

References 30 publications

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“…This concept of adequate patient selection is currently also the basis of the stepwise therapy associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Because after an international registry showed a higher mortality after ALPPS in patients aged above 61 years [27], now this procedure is recommended only for selected, e.g. young patients [28].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with contralateral liver hypertrophy after unilateral radioembolization for hepatocellular carcinoma

et al. 2017

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IntroductionRadioembolization for the treatment of hepatocellular carcinoma (HCC) induces liver volume changes referred to as “atrophy-hypertrophy complex”. The aim of this study was to investigate lobar liver volume changes after unilateral radioembolization and to search for factors associated with hypertrophy of the untreated lobe.Materials and methodsSeventy-five patients were retrospectively evaluated. Inclusion criteria were: (1) right-lobar radioembolization for unresectable unilateral HCC, (2) available liver computed tomography scans before, 1, 3, and at least 6 months after radioembolization. Baseline patient characteristics included clinical features, laboratory results, spleen volume, and liver computed tomography. Absolute and relative (referred to the whole liver volume) liver lobe volumes (LLV) as well as relative LLV (rLLV) change per month were evaluated and compared.ResultsAbsolute and relative contralateral LLV continuously increased after radioembolization (p<0.001). Mean relative contralateral LLV increased from 36±11.6% before radioembolization to 50±15.3% 6 months after radioembolization. Median contralateral rLLV increase/month (within first 6 months) was 2.5%. Contralateral rLLV increase/month was significantly lower in patients with ascites (p = 0.017) or platelet count <100/nl (p = 0.009). An inverse correlation of contralateral rLVV increase/month with spleen volume (p = 0.017), patient age (p = 0.024), Child Pugh score (p = 0.001), and tumor burden (p = 0.001) was found.ConclusionsSignificant contralateral hypertrophy and ipsilateral atrophy were common after unilateral radioembolization. Small spleen volume, low patient age, low Child Pugh score, absence of ascites, platelet count ≥100/nl, and low tumor burden were associated with increased contralateral hypertrophy, indicating that younger patients with compensated cirrhosis might benefit most from radioembolization in a “bridge-to-resection” setting.

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Section: Discussionmentioning

confidence: 99%

Factors associated with contralateral liver hypertrophy after unilateral radioembolization for hepatocellular carcinoma

et al. 2017

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“…Then, resection is performed when the future remnant liver volume is more than 30–40% of the standardized liver volume. Preoperative evaluation should include liver cirrhosis, the patient’s age and ability to tolerate two surgeries within a short period of time, and the risk of rapid tumor progression [53]. Laparoscopy or ablation can be used to minimize the trauma associated with the procedure [54].…”

Section: Treatmentmentioning

confidence: 99%

Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

Zhou¹,

Sun²,

Wang³

et al. 2018

Liver Cancer

480

449

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Background: Hepatocellular carcinoma (HCC) (about 85–90% of primary liver cancer) is particularly prevalent in China because of the high prevalence of chronic hepatitis B infection. HCC is the fourth most common malignancy and the third leading cause of tumor-related deaths in China. It poses a significant threat to the life and health of Chinese people. Summary: This guideline presents official recommendations of the National Health and Family Planning Commission of the People’s Republic of China on the surveillance, diagnosis, staging, and treatment of HCC occurring in China. The guideline was written by more than 50 experts in the field of HCC in China (including liver surgeons, medical oncologists, hepatologists, interventional radiologists, and diagnostic radiologists) on the basis of recent evidence and expert opinions, balance of benefits and harms, cost-benefit strategies, and other clinical considerations. Key Messages: The guideline presents the Chinese staging system, and recommendations regarding patients with HCC in China to ensure optimum patient outcomes.

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“…The ALPPS procedure resulted in a quadrupled mortality rate, doubled median hospital stay, and doubled risk for PLF in patients with intermediate-stage HCC [132] and should therefore only be applied in HCC patients with low-grade fibrosis. ALPPS should not, or with great caution, be applied in patients with perihilar and intrahepatic CCA due to the (already) high postoperative mortality rate in this patient category [130,133].…”

Section: Enlarging Of Future Remnant Liver Volumementioning

confidence: 99%

Liver resection for cancer: New developments in prediction, prevention and management of postresectional liver failure

Mierlo

Schaap

Dejong

et al. 2016

Journal of Hepatology

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Should ALPPS be Used for Liver Resection in Intermediate-Stage HCC?

Cited by 84 publications

References 30 publications

Factors associated with contralateral liver hypertrophy after unilateral radioembolization for hepatocellular carcinoma

Factors associated with contralateral liver hypertrophy after unilateral radioembolization for hepatocellular carcinoma

Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition)

Liver resection for cancer: New developments in prediction, prevention and management of postresectional liver failure

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