The ALPPS procedure: hepatocellular carcinoma as a main indication. An Italian single-center experience

Vennarecci, Giovanni; Ferraro, Daniele; Tudisco, Antonella; Sandri, Giovanni Battista Levi; Guglielmo, Nicola; Berardi, Giammauro; Sperduti, Isabella; Ettorre, Giuseppe Maria

doi:10.1007/s13304-018-0596-3

Cited by 22 publications

(12 citation statements)

References 31 publications

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“…The ALPPS registry did not reveal any morbidity or mortality rates after rescue ISLT [5]. However, our patient collective demonstrated an average age of 67 years; this might be relevant for the interpretation of the herein reported mortality because patient age beyond 60 years is associated with an increased risk for morbidity and mortality due to impaired regenerative potential [45].…”

Section: Discussionmentioning

confidence: 54%

In situ split plus portal vein ligation (ISLT) – a salvage procedure following inefficient portal vein embolization to gain adequate future liver remnant volume prior to extended liver resection

Lehwald

Vaghiri

Esch³

et al. 2020

BMC Surg

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Background: Right extended liver resection is frequently required to achieve tumor-free margins. Portal venous embolization (PVE) of the prospective resected hepatic segments for conditioning segments II/III does not always induce adequate hypertrophy in segments II and III (future liver remnant volume (FLRV)) for extended rightresection. Here, we present the technique of in situ split dissection along segments II/III plus portal disruption to segments IV-VIII (ISLT) as a salvage procedure to overcome inadequate gain of FLRV after PVE. Methods: In eight patients, FLRV was further pre-conditioned following failed PVE prior to hepatectomy (ISLTgroup). We compared FLRV changes in the ISLT group with patients receiving extended right hepatectomy following sufficient PVE (PVEres-group). Survival of the ISLT-group was compared to PVEres patients and PVE patients with insufficient FLRV gain or tumor progress who did not receive further surgery (PVEnores-group). Results: Patient characteristics and surgical outcome were comparable in both groups. The mean FLRV-to-bodyweight ratio in the ISLT group was smaller than in the PVEres-group pre-and post-PVE. One intraoperative mortality due to a coronary infarction was observed for an ISLT patient. ISLT was successfully completed in the remaining seven ISLT patients. Liver function and 2-year survival of~50% was comparable to patients with extended right hepatectomy after efficient PVE. Patients who received a PVE but who were not subsequently resected (PVEnores) demonstrated no survival beyond 4 months.

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Section: Discussionmentioning

confidence: 54%

In situ split plus portal vein ligation (ISLT) – a salvage procedure following inefficient portal vein embolization to gain adequate future liver remnant volume prior to extended liver resection

Lehwald

Vaghiri

Esch³

et al. 2020

BMC Surg

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“…The surgical indication for HCC with intrahepatic tumor thrombus is the most novel aspect of this case. The application of ALPPS for large HCC has been associated with variable results in the literature . The most important factor limiting the application of ALPPS in patients affected by HCC is the presence of fibrosis and cirrhosis that may limit regeneration, along with the increased risk of both interstage and overall morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…The application of ALPPS for large HCC has been associated with variable results in the literature. [25][26][27][28] The most important factor limiting the application of ALPPS in patients affected by HCC is the presence of fibrosis and cirrhosis that may limit regeneration, along with the increased risk of both interstage and overall morbidity. In our case, despite the presence of chronic HBV infection, there were no signs of cirrhosis or reduced liver function, as indicated by normal blood tests, and no evidence of clinically significant portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

Full robotic ALPPS for HCC with intrahepatic portal vein thrombosis

Benedetto

Assirati

Magistri

2020

Robotics Computer Surgery

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Background The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique can induce a greater degree of hypertrophy of the future liver remnant (FLR) in a shorter time compared with other procedures. A robotic approach may reduce the complication rate, increasing the ability to perform classic ALPPS. Methods We report technical and clinical considerations on the first full robotic ALPPS (stages 1 and 2) for hepatocellular carcinoma (HCC) with portal vein intrahepatic tumor thrombus. Results The patient was a 38‐year‐old man with Milan‐out HCC and FLR volume of 19.6%. On postoperative day (POD) 8, FLR increased to 37%; therefore, he underwent completion of ALPPS on POD 10. The postoperative course was uneventful, and the patient was discharged in good general conditions on POD 3. Conclusion Robotic ALPPS is safe and feasible for selected patients with initially unresectable HCC or requiring extended resections, with good postoperative outcomes.

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“…55 The experiences from Hong Kong, Rome and Fudan show that in selected patients ALPPS seems to be an attractive approach to increase resectability in HCC patients otherwise left with palliative treatment options. [54][55][56]…”

Section: Phc 5%mentioning

confidence: 99%

Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Registry: What Have We Learned?

2020

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In 2007, the first associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure was performed in Regensburg, Germany. ALPPS is a variation of twostage hepatectomy to induce rapid liver hypertrophy allowing the removal of large tumors otherwise considered irresectable due to a too small future liver remnant. In 2012, the international ALPPS registry was created, and it now contains more than 1,000 cases. During the past years, improved patient selection and refinements in operative techniques, in particular, less invasive approaches such as Partial ALPPS, Tourniquet ALPPS, Ablation-assisted ALPPS, Hybrid ALPPS or Laparoscopic or Robotic approaches, have resulted in significant improvements in safety. The most frequent indication for ALPPS is colorectal liver metastases. In the first randomized controlled study, ALPPS provided a higher resectability rate than conventional two-stage hepatectomy, with similar complication rates. Long-term outcome data are still missing. The initial results of ALPPS for hepatocellular carcinoma and for perihilar cholangiocarcinoma were devastating, but with progress in surgical technic and better patient selection, ALPPS could serve as a treatment alternative in carefully selected cases, even for these tumors. ALPPS has enlarged the armamentarium of hepato-pancreato-biliary surgeons, but there is still discussion regarding how to use this novel technique, which may allow resection of tumors that are otherwise deemed irresectable.

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The ALPPS procedure: hepatocellular carcinoma as a main indication. An Italian single-center experience

Cited by 22 publications

References 31 publications

In situ split plus portal vein ligation (ISLT) – a salvage procedure following inefficient portal vein embolization to gain adequate future liver remnant volume prior to extended liver resection

In situ split plus portal vein ligation (ISLT) – a salvage procedure following inefficient portal vein embolization to gain adequate future liver remnant volume prior to extended liver resection

Full robotic ALPPS for HCC with intrahepatic portal vein thrombosis

Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Registry: What Have We Learned?

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