Associating liver partition and portal vein ligation (ALPPS): Taking a view of trails

Takamoto, Takeshi; Sugawara, Yasuhiko; Hashimoto, Takeji; Makuuchi, Masatoshi

doi:10.5582/bst.2015.01131

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…Accordingly, pertinent data were benchmarked against reported findings by others. Firstly, we observed more extensive liver growth in the ALPPS group compared to the PVL group, which is in accordance with the experimental and clinical literature [ 6 , 20 , 23 , 24 , 25 ]. The increase in the Ki67 index shows efficient hepatocyte proliferation in the non-ligated lobe, indicating that the liver growth is not due to cellular swelling, which is also supported by previous findings [ 26 ].…”

Section: Discussionsupporting

confidence: 91%

“…The initiation, propagation, and termination of accelerated liver regeneration following ALPPS are orchestrated by a series of intricate signals and pathways [ 6 , 7 ], although the exact mechanisms are still not fully understood. Bile acids (BAs) occupy a central role in the early phase of liver regeneration [ 8 ] and it is therefore plausible that BAs also mediate liver regeneration after ALPPS.…”

Section: Introductionmentioning

confidence: 99%

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The Role of Farnesoid X Receptor in Accelerated Liver Regeneration in Rats Subjected to ALPPS

et al. 2021

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Background: the role of bile acid (BA)-induced farnesoid X receptor (Fxr) signaling in liver regeneration following associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was investigated in a rat model. Methods: Male Wistar rats underwent portal vein ligation (PVL) (n = 30) or ALPPS (n = 30). Animals were sacrificed pre-operatively and at 24, 48, 72, or 168 h after intervention. Regeneration rate, Ki67 index, hemodynamic changes in the hepatic circulation, and BA levels were assessed. Transcriptome analysis of molecular regulators involved in the Fxr signaling pathway, BA transport, and BA production was performed. Results: ALLPS induced more extensive liver regeneration (p < 0.001) and elevation of systemic and portal BA levels (p < 0.05) than PVL. The mRNA levels of proteins participating in hepatic Fxr signaling were comparable between the intervention groups. More profound activation of the intestinal Fxr pathway was observed 24 h after ALPPS compared to PVL. Conclusion: Our study elaborates on a possible linkage between BA-induced Fxr signaling and accelerated liver regeneration induced by ALPPS in rats. ALPPS could trigger liver regeneration via intestinal Fxr signaling cascades instead of hepatic Fxr signaling, thereby deviating from the mechanism of BA-mediated regeneration following one-stage hepatectomy.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The Role of Farnesoid X Receptor in Accelerated Liver Regeneration in Rats Subjected to ALPPS

et al. 2021

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“…A bile leak is reported in up to 20% of patients (ordinary hepatectomy <5%), and this is also associated with the sepsis caused by liver parenchymal necrosis. [36,84] Intraoperative cholangiography, routine use of T-tube drainage, and other approaches were also discussed at the first international meeting on ALPPS. [83] The incidence of bile leakage will presumably decrease as ALPPS is modified and refined.…”

Section: Controversymentioning

confidence: 99%

An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence

et al. 2016

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The main obstacle to achieving an R0 resection after a major hepatectomy is inability to preserve an adequate future liver remnant (FLR) to avoid postoperative liver failure (PLF). Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel technique for resecting tumors that were previously considered unresectable, and this technique results in a vast increase in the volume of the FLR in a short period of time. However, this technique continues to provoke heated debate because of its high mortality and morbidity.The evolution of ALPPS and its advantages and disadvantages have been systematically reviewed and evaluated in accordance with current evidence. Electronic databases (PubMed and Medline) were searched for potentially relevant articles from January 2007 to January 2016.ALPPS has evolved into various modified forms. Some of these modified techniques have reduced the difficulty of the procedure and enhanced its safety. Current evidence indicates that the advantages of ALPPS are rapid hypertrophy of the FLR, the feasibility of the procedure, and a higher rate of R0 resection in comparison to other techniques. However, ALPPS is associated with worse major complications, more deaths, and early tumor recurrence.Hepatobiliary surgeons should carefully consider whether to perform ALPPS. Some modified forms of ALPPS have reduced the mortality and morbidity of the procedure, but they cannot be recommended over the original procedure currently. Portal vein embolization (PVE) is still the procedure of choice for patients with a tumor-free FLR, and ALPPS could be used as a salvage procedure when PVE fails. More persuasive evidence needs to be assembled to determine whether ALPPS or two-stage hepatectomy (TSH) is better for patients with a tumor involving the FLR. Evidence with regard to long-term oncological outcomes is still limited. More meticulous comparative studies and studies of the 5-year survival rate of ALPPS could ultimately help to determine the usefulness of ALPPS. Indications and patient selection for the procedure need to be determined.

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“…E. Schadde и соавт. было показано, что ежедневный прирост после ALPPS в 11 раз больше, чем после ЭВВ (34,8 см 3 в день в сравнении с 3 см 3 в день) [10][11][12][13][14][15][16]. Однако индуцированные гепатоциты после ALPPS являются менее функционально зрелыми по сравнению с гепатоцитами после ЭВВ [25,26].…”

Section: Discussionunclassified

“…Вместе с тем 90-дневная летальность составила 9%, а частота серьезных послеоперационных осложнений (>IIIb по Clavien-Dindo) -27%. На 25 июля 2016 г. в международном регистре ALPPS описано 715 вмешательств [11][12][13][14][15][16].…”

Section: вве де ниеunclassified

Portal Vein Embolization and ALPPS for Prevention of Post-Hepatectomy Liver Failure

Щерба¹,

Efimov²,

Кирковский³

et al. 2016

Ann. hir. gepatol.

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Цель. Оценить ближайшие и отдаленные результаты эмболизации воротной вены и ALPPS в профилактике пострезекционной печеночной недостаточности. Материал и методы. С 2008 по 2016 г. выполнено 358 резекций печени. Обширная резекция (≥4 сегментов) выполнена у 132 (36,9%) больных. Холангиоцеллюлярная карцинома диагностирована у 48 (36,4%) пациентов, гепатоцеллюлярная карцинома-у 23 (17,4%), метастазы колоректального рака-у 19 (14,4%), паразитарные болезни печени (эхинококкоз, альвеококкоз)-у 31 (23,5%), другие заболевания-у 11 (8,3%). Сосудистая резекция была выполнена 42 (31,8%) больным, резекция общего желчного и (или) общего печеночного протока-76 (57,6%). Анализу подвергли группу пациентов, перенесших обширную резекцию печени: ALPPS-6 наблюдений, двухэтапные резекции с эмболизацией воротной вены-41 пациент (исследуемая группа), обширная резекция печени без эмболизации воротной вены-85 пациентов (группа контроля). Показанием к дооперационной эмболизации воротной вены считали FLR/SLV < 31%. Частоту пострезекционной печеночной недостаточности оценивали по критериям ISGLS. Результаты. Эмболизация воротной вены была эффективна у 41 (66,1%) пациента, относительный прирост остаточного объема печеночной ткани составил 52% (33,3; 61), средний срок-5 (4,0; 6,5) нед. По результатам ALPPS в срок 11 (7; 17) дней удалось добиться относительного увеличения FLR на 70% (60; 77), в 1 наблюдении эффективного прироста не было (FLR 30% за 24 дня). После обширной резекции печени клинически значимая (степень B и C) печеночная недостаточность развилась у 66 (50%) пациентов, инфекционные осложнения-у 39 (29,5%), билиарные осложнения-у 29 (21,9%), кровотечение (степень C по ISGLS)-у 5 (3,8%). Госпитальная летальность составила 8,3%. Применение эмболизации воротной вены позволило уменьшить частоту пострезекционной печеночной недостаточности степени C (7,3 и 20%; р = 0,07). Заключение. Двухэтапный подход к резекции печени с эмболизацией или лигированием воротной вены на первом этапе позволяет уменьшить частоту пострезекционной печеночной недостаточности. Для определенной группы пациентов ALPPS является единственным способом, позволяющим выполнить радикальную операцию и сохранить необходимый объем печеночной паренхимы, но с непредсказуемыми отдаленными результатами.

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Associating liver partition and portal vein ligation (ALPPS): Taking a view of trails

Cited by 8 publications

References 18 publications

The Role of Farnesoid X Receptor in Accelerated Liver Regeneration in Rats Subjected to ALPPS

The Role of Farnesoid X Receptor in Accelerated Liver Regeneration in Rats Subjected to ALPPS

An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence

Portal Vein Embolization and ALPPS for Prevention of Post-Hepatectomy Liver Failure

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