10th Anniversary of ALPPS—Lessons Learned and quo Vadis

Abstract

Although ALPPS is now an established 2-stage hepatectomy additional data are warranted to further refine indication and technical aspects. Long-term oncological outcome results are needed to establish the place of ALPPS in patients with initially nonresectable liver tumors.

Prognosis in patients with synchronous colorectal cancer metastases after complete resection of the primary tumor and the metastases

“…The use of these treatment strategies to convert unresectable metastases to resectable ones and to further treat patients after tumor relapse has not been documented in our database, but they have a certain part in improving prognosis. Improvements in surgery comprise advanced strategies in liver surgery such as portal vein embolization, staged hepatectomies, and associating liver partition and portal vein ligation for staged hepatectomy . In peritoneal carcinomatosis, cytoreductive surgery with HIPEC has demonstrated its benefit for patients with CRC metastases .…”

Full robotic ALPPS for HCC with intrahepatic portal vein thrombosis

“…Nevertheless, there is a high rate of failure due to the procedure's complexity and invasiveness. Classical two‐stage hepatectomies often cannot be completed due to disease progression between stages 1 and 2; however, in ALPPS, this paradigm has been overturned by the results . Post–stage 2 liver failure represents the cause of mortality in most reported cases, and a reduced morbidity after stage 1 has been advocated as a possible key factor in reducing the risk of fatal complications after ALPPS completion .…”

“…Besides, with the difficulties in handling the right lobe using minimally invasive approaches due to its conformation, the robot can minimize the manipulation of the liver and fulfill the no‐touch concept. Understanding the case‐specific liver vascular anatomy is another factor that can reduce morbidity between stages 1 and 2, reducing the risk of massive parenchymal necrosis . By accurately studying the patient's anatomy through the 3D reconstructed model, we increased our ability to identify and preserve an optimal outflow intraoperatively and respect arterial inflow until stage 2, especially for segment IV.…”

“…The ALPPS technique has been demonstrated to induce a greater degree of hypertrophy of the future liver remnant (FLR) in a shorter time compared with that by portal vein ligation or embolization, increasing the chances to achieve a superior rate of R0 resection margin . First described for cases of perihilar cholangiocarcinoma, currently, ALPPS is indicated to treat several clinical conditions, not only for formal right trisectionectomies but also for right hepatectomies in liver steatosis and other underlying parenchymal injuries . The major drawback of this procedure is the increased risk of morbidity, with mortality rates initially reported to be approaching 27% at the beginning of the experience in the literature.…”

“…2 First described for cases of perihilar cholangiocarcinoma, currently, ALPPS is indicated to treat several clinical conditions, not only for formal right trisectionectomies but also for right hepatectomies in liver steatosis and other underlying parenchymal injuries. 3 The major drawback of this procedure is the increased risk of morbidity, with mortality rates initially reported to be approaching 27% at the beginning of the experience in the literature.…”