ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) does not affect proliferation, apoptosis, or angiogenesis as compared to standard liver resection for colorectal liver metastases

Joechle, Katharina; Moser, Christian; Ruemmele, Petra; Schmidt, Katharina; Werner, Jens; Geissler, Edward K.; Schlitt, Hans J.; Lang, Sven A.

doi:10.1186/s12957-017-1121-8

Cited by 9 publications

(7 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CRLM confers the best clinical outcomes; a series by Hernandez-Alejandro involving 14 patients who underwent ALPPS for planned liver resection of CRLM demonstrated low morbidity (14% Clavien-Dindo ≥ Grade IIIB) and no mortality (23). In addition, a recent study by Joechle et al has demonstrated that there is no difference between ALPPS and standard liver resection on tumour cell proliferation, apoptosis and vascularization in CRLM (18).…”

Section: Guide On Patient Selectionmentioning

confidence: 99%

“…Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is a novel two-staged procedure which aims to induce rapid hypertrophy of the FLR (18,19). ALPPS was first formally reported in a poster presentation by de Santibañes et al in 2011 (20), and subsequently described in a landmark study involving 25 patients by Schnitzbauer et al in 2012 (21).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Associated liver partition and portal vein ligation for staged hepatectomy: a review

Chan¹,

Low²,

Shelat³

2020

Transl Gastroenterol Hepatol

View full text Add to dashboard Cite

Outcomes of liver resection have improved with advances in surgical techniques, improvements in critical care and expansion of resectability criteria. However, morbidity and mortality following liver resection continue to plague surgeons. Post-hepatectomy liver failure (PHLF) due to inadequate future liver remnant (FLR) is an important cause of morbidity and mortality following liver resection. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel two-staged procedure described in 2012, which aims to induce rapid hypertrophy of the FLR unlike conventional two-stage hepatectomy, which require a longer time for FLR hypertrophy. Careful patient selection and modifications in surgical technique has improved morbidity and mortality rates in ALPPS. Colorectal liver metastases (CRLM) confers the best outcomes post-ALPPS. Patients <60 years old and low-grade fibrosis with underlying hepatocellular carcinoma (HCC) are also eligible for ALPPS. Evidence for other types of cancers is less promising. Current studies, though limited, demonstrate that ALPPS has comparable oncological outcomes with conventional two-stage hepatectomy. Modifications such as partial-ALPPS and mini-ALPPS have shown improved morbidity and mortality compared to classic ALPPS. ALPPS may be superior to conventional two-stage hepatectomy in carefully selected groups of patients and has a promising outlook in liver surgery.

show abstract

Section: Guide On Patient Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Associated liver partition and portal vein ligation for staged hepatectomy: a review

Chan¹,

Low²,

Shelat³

2020

Transl Gastroenterol Hepatol

View full text Add to dashboard Cite

show abstract

“…Similarly, data regarding proliferation indices (Ki67 index) are contradictory in literature. While Fukami et al [55] found an increase in Ki67 from 60 to 80% between step 1 and 2 in ALPPS, Joechle et al[56]. did not reveal any difference in Ki67 between ALPPS or conventional hepatectomy…”

mentioning

confidence: 98%

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Lang¹,

Baumgart²,

Mittler³

2018

Dig Surg

View full text Add to dashboard Cite

Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has expanded the surgical armamentarium for patients with advanced and bilateral colorectal liver metastases. However, the enthusiasm that the medical fraternity had about ALPPS was hampered by a high mortality rate and early and frequent tumor recurrence. While surgical safety has improved, mainly due to technical refinements and a better patient selection, the oncological value in the face of early tumor recurrence remains unclear. The only randomized controlled trial on ALPPS versus two-stage hepatectomy (TSH) so far confirmed that ALPPS led to higher resectability with comparable perioperative complication rate, but oncological outcome was not measured. Robust data regarding long-term outcome are still missing. TSH and ALPPS might be complementary strategies for the resection of colorectal liver metatsases (CRLM) with ALPPS being reserved for patients with no other surgical option, that is, after failed portal vein embolization or those with an extremely small future liver remnant. In other words, ALPPS can be considered a supplementary tool and a last resort in the liver surgeon’s hand to offer resectability in otherwise nonresectable CRLM. In these individual cases, and always embedded into a multimodal treatment setting, ALPPS may offer a chance of complete tumor removal and prolonged survival and even a chance for cure.

show abstract

“…Tanaka et al[8] compared Ki67 expression in both approaches showing significantly induced of Ki67 index in PVE but not ALPPS patients. Joechle et al[20] concluded that markers of tumor proliferation and angiogenesis were similar among patients undergoing ALPPS and standard liver resection.…”

Section: Alpps: Better Than Two-stage Hepatectomy?mentioning

confidence: 99%

Current status of associating liver partition with portal vein ligation for staged hepatectomy: Comparison with two-stage hepatectomy and strategies for better outcomes

Chan

2019

WJG

View full text Add to dashboard Cite

Since its introduction in 2012, associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) has significantly expanded the pool of candidates for liver resection. It offers patients with insufficient liver function a chance of a cure. ALPPS is most controversial when its high morbidity and mortality is concerned. Operative mortality is usually a result of post-hepatectomy liver failure and can be minimized with careful patient selection. Elderly patients have limited reserve for tolerating the demanding operation. Patients with colorectal liver metastasis have normal liver and are ideal candidates. ALPPS for cholangiocarcinoma is technically challenging and associated with fair outcomes. Patients with hepatocellular carcinoma have chronic liver disease and limited parenchymal hypertrophy. However, in selected patients with limited hepatic fibrosis satisfactory outcomes have been produced. During the inter-stage period, serum bilirubin and creatinine level and presence of surgical complication predict mortality after stage II. Kinetic growth rate and hepatobiliary scintigraphy also guide the decision whether to postpone or omit stage II surgery. The outcomes of ALPPS have been improved by a combination of technical modifications. In patients with challenging anatomy, partial ALPPS potentially reduces morbidity, but remnant hypertrophy may compare unfavorably to a complete split. When compared to conventional two-stage hepatectomy with portal vein embolization or portal vein ligation, ALPPS offers a higher resection rate for colorectal liver metastasis without increased morbidity or mortality. While ALPPS has obvious theoretical oncological advantages over two-stage hepatectomy, the long-term outcomes are yet to be determined.

show abstract

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) does not affect proliferation, apoptosis, or angiogenesis as compared to standard liver resection for colorectal liver metastases

Cited by 9 publications

References 39 publications

Associated liver partition and portal vein ligation for staged hepatectomy: a review

Associated liver partition and portal vein ligation for staged hepatectomy: a review

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Current status of associating liver partition with portal vein ligation for staged hepatectomy: Comparison with two-stage hepatectomy and strategies for better outcomes

Contact Info

Product

Resources

About