ALPPS and similar resection procedures in treating extensive hepatic metastases: Our own experiences and critical discussion

Abstract

Selected patients can be successfully treated by ALPPS in terms of an R0-resection. However, risk of tumor recurrence and rate of complications are high.

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in colorectal liver metastasis: the radiologist’s perspective

“…This method provides a strategy to induce faster and more marked FLR hypertrophy as well as a way to avoid PHLF following borderline liver resections [2,8,11,[16][17][18][19].…”

“…Associating liver partition and PVL for staged hepatectomy which is also referred to as the ALPPS procedure is the most recently described liver resection technique; in particular, it represents an advantageous strategy to induce a rapid and marked increase in the FLR volume [2,8,11,[16][17][18][19][20].…”

“…ALPPS has been performed in different surgical scenarios with at least three major variations, and the initial experience of specialized oncologic centers has recently been reported with promising results [2,8,11,[16][17][18][19].…”

GOOD TO KNOW: The ALPPS Procedure - Embracing a New Technique

“…Both methods require a reintervention to suppress them if FLR hypertrophy is not optimal and the removal of the tumoral hemiliveris not completed. This disadvantage is solved by: using a Foley catheter (13), omentoplasty (37), applying fibrin glue to the transection surface, using acellular collagen membranes or argon beam coagulation.…”

Feeding the Hedgehog: A new meaning for JNK signalling in liver regeneration

“…Indeed, in many clinical scenarios liver regeneration is not sufficient to circumvent loss of a large volume of hepatic tissue, with detrimental effects on the survival of the recovering patient. 3,4 It is now appreciated that liver regeneration involves compensatory growth followed by proliferation of all adult cells that compose the liver including hepatocytes, sinusoidal endothelial cells, biliary epithelial cells, Kupffer cells and hepatic stellate cells (HSCs). 1,2 Although the mechanisms behind the failure of liver regeneration are not entirely clear, research in the field has aided the development of a new surgical procedure to promote an accelerated liver regeneration, 5,6 opening up the benefits of liver resection to the wider populations of patients undergoing extensive liver resection.…”