The ALPPS procedure for hepatocellular carcinoma larger than 10 centimeters

Torres, Orlando Jorge Martins; Vasques, Rodrigo Rodrigues; Silva, Thiago Henrique S.; Torres, Camila

doi:10.1016/j.ijscr.2016.07.039

Cited by 9 publications

(5 citation statements)

References 11 publications

(22 reference statements)

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“…Remarkable hypertrophy has been observed in ALPPS for HCC, even in patients with low-grade fibrosis. [21][22][23] In order to minimise the impact of the first stage, some authors have suggested a combination of hanging manoeuvre and anterior approach in cirrhotic patients. This procedure seems to be better performed by robotic approach than laparoscopically and is associated with reduced blood loss and minimal morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…This procedure seems to be better performed by robotic approach than laparoscopically and is associated with reduced blood loss and minimal morbidity and mortality. [21][22][23] Schadde et al observed that MELD score over 10 before stage-2 is an independent predictor of 90-day mortality, in addition to previously defined risk factors. The disease-free at 1 year was 87% and 90-day mortality was 12%.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, partial ALPPS was performed in one patient. [21][22][23] As far as we know, this is the first series of patients underwent totally robotic ALPPS for HCC in cirrhotic liver.…”

Section: Discussionmentioning

confidence: 99%

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Total robotic ALPPS approach for hepatocellular carcinoma in cirrhotic liver

Fernandes

Barros

Magistri

et al. 2021

Robotics Computer Surgery

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Background Hepatocellular carcinoma (HCC) is a common indication for associating liver partition with portal vein ligation for staged hepatectomy (ALPPS). Robotic liver resection has been done for HCC, but robotic ALPPS is a rare procedure. Methods To present three cases of totally robotic ALPPS in cirrhotic patients with HCC. Results Three cirrhotic male patients with HCC underwent ALPPS; the mean age was 54.3 years. MELD score was ≤9 and tumour size between 90 and 140 mm. The mean hypertrophy of the future liver remnant after the first stage was 77.5% and no postoperative liver failure was reported. Mean operative time of stage 1 was 7:30 h and of stage 2 was 4:37 h, without blood transfusion. The mean hospital stay for the first stage was 10 days and for the second stage was 9.3 days. No postoperative complication was recorded. Conclusions Robotic ALPPS in cirrhotic patients with HCC is safe and feasible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Total robotic ALPPS approach for hepatocellular carcinoma in cirrhotic liver

Fernandes

Barros

Magistri

et al. 2021

Robotics Computer Surgery

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“…Currently available evidence indicates the incidence of morbidity and mortality is high among HCC and IHCC patients treated using ALPPS [ 26 , 27 , 38 , 49 , 50 , 52 , 54 , 57 , 58 , 69 , 70 ]. In the first edition of the ALPPS World Registry [ 37 ], the 90-day mortality was reported to be 9%, but it was higher for HCC (12%), IHCC (13%), perihiliar cholangiocarcinoma (27%) and gallbladder carcinoma (33%) than in cases of colorectal liver metastasis (CRLM) (8%).…”

Section: Discussionmentioning

confidence: 99%

Tourniquet-ALPPS is a promising treatment for very large hepatocellular carcinoma and intrahepatic cholangiocarcinoma

et al. 2018

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When very large hepatocellular carcinomas (HCCs) and intrahepatic cholangiocarcinoma (IHCCs) with insufficient future liver remnants are treated using associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), the outcome is often poor. We therefore tested the efficacy of a modified version of that technique, tourniquet-ALPPS. A review of the literature examining outcomes of HCC and IHCC patients treated with ALPPS revealed the incidences of morbidity ≥ III and postoperative mortality to be respectively 20.7% and 16.1% among HCC patients and 50% and 45.4% among IHCC patients. In the present case series, in which HCC and IHCC patients were treated with tourniquet-ALPPS, median tumor size was 100 mm (range: 70–200 mm). After surgical stage I, there was no morbidity, no mortality and the median future liver remnant had increased at day 7 by 76%. In surgical stage II, 100% of tumors were resectable (8 right trisectionectomies, 5 with inferior vena cava resection). Two patients experienced serious morbidity ≥ IIIB and 1 patient died (11%). One- and 3-year overall survival was 75% and 60%, respectively. Thus tourniquet-ALPPS appears to be an effective alternative to classical ALPPS for the treatment of patients with HCC or IHCC.

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“…Furthermore ALPPS for huge HCC has been reported without an increased risk of morbidity or mortality (10). In the reported case, a multimodal therapy was the winning strategy.…”

Section: Introductionmentioning

confidence: 87%

Associating liver partition and portal vein ligation for bleeding hepatocellular carcinoma in HBV cirrhosis: a safety strategy

Sandri

Vennarecci

Lepiane

et al. 2017

Transl. Gastroenterol. Hepatol.

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The incidence of hepatocellular carcinoma (HCC) spontaneous tumor rupture varies between 3% and 26%. For resectable HCC ruptures, emergency hepatectomy or staged hepatectomy after transcatheter arterial embolization (TAE) are life-saving procedures, and efficient therapeutic methods. We report a multimodal therapy including TAE, associating liver partition and portal vein ligation (ALPPS) and immunoglobuline infusion for a huge bleeding HCC with portal vein tumor thrombosis (PVTT) in hepatitis B virus (HBV) cirrhosis. ALPPS first step began with an abdominal toilette due to the massive hemoperitoneum and a portal vein incision at the bifurcation of the right and left portal veins was performed.A freely floating left part of the thrombus was extracted from the left portal vein in order to restore the left portal vein. The right portal vein with complete thrombosis was closed. Liver partition was then performed. The second step was performed without complications. A HCC Edmondson grade 4 (pT3b) and a cirrhotic liver parenchyma were described. Postoperative ascites decompensation was treated and patient was discharged in postoperative day 21. The reported triple strategy allowed us to prolong patient live. A multimodal therapy including TAE, ALPPS and immunoglobuline is a good option for a life treatment in case of huge bleeding hepatocellular carcinoma with PVTT in HBV cirrhosis.

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The ALPPS procedure for hepatocellular carcinoma larger than 10 centimeters

Cited by 9 publications

References 11 publications

Total robotic ALPPS approach for hepatocellular carcinoma in cirrhotic liver

Total robotic ALPPS approach for hepatocellular carcinoma in cirrhotic liver

Tourniquet-ALPPS is a promising treatment for very large hepatocellular carcinoma and intrahepatic cholangiocarcinoma

Associating liver partition and portal vein ligation for bleeding hepatocellular carcinoma in HBV cirrhosis: a safety strategy

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