Chance and challenge of associating liver partition and portal vein ligation for staged hepatectomy

Fei, Xiang; Hu, Zemin

doi:10.1016/j.hbpd.2019.04.006

Cited by 8 publications

(8 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although ALPPS used to be adopted for patients with primary hepatobiliary tumors requiring extensive liver resection in earlier stages, several subsequent series analyses reported unsatisfactory perioperative results in this population, necessitating a reevaluation of the surgical indications (31,32). It becomes clear that CRLM had the lowest risks of complication and mortality after ALPPS, which was explained as a consequence of the favorable tumor biology and normal liver (33)(34)(35). Over the past few years, several meta-analyses have been conducted to compare ALPPS with TSH or other traditional FLR augmentation strategies but mainly for mixed indications ( Supplementary Table 4) (16, 30,[36][37][38][39][40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Conventional Two-Stage Hepatectomy or Associating Liver Partitioning and Portal Vein Ligation for Staged Hepatectomy for Colorectal Liver Metastases? A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

Background: Pushing the surgical limits for initially unresectable colorectal liver metastases (CRLM) are two approaches for sequential liver resection: two-stage hepatectomy (TSH) and associating liver partitioning and portal vein ligation for staged hepatectomy (ALPPS). However, the role of each treatment modality remains ill-defined. The present meta-analysis was designed to compare the safety, efficacy, and oncological benefits between ALPPS and TSH in the management of advanced CRLM. Methods: A systematic literature search was conducted from online databases through to February 2020. Single-arm synthesis and cumulative meta-analysis were performed. Results: Eight studies were included, providing a total of 409 subjects for analysis (ALPPS: N = 161; TSH: N = 248). The completions of the second stage of the hepatectomy [98 vs. 78%, odds ratio (OR) 5.75, p < 0.001] and R0 resection (66 vs. 37%; OR 4.68; p < 0.001) were more frequent in patients receiving ALPPS than in those receiving TSH, and the waiting interval was dramatically shortened in ALPPS (11.6 vs. 45.7 days, weighted mean difference = −35.3 days, p < 0.001). Nevertheless, the rate of minor complications was significantly higher in ALPPS (59 vs. 18%, OR 6.5, p < 0.001) than in TSH. The two treatments were similar in 90-day mortality (7 vs. 5%, p = 0.43), major complications (29 vs. 22%, p = 0.08), posthepatectomy liver failure (PHLF; 9 vs. 9%, p = 0.3), biliary leakage (11 vs. 14%, p = 0.86), length of hospital stay (27.95 vs. 26.88 days, p = 0.8), 1-year overall survival (79 vs. 84%, p = 0.61), 1-year recurrence (49 vs. 39%, p = 0.32), and 1-year disease-free survival (34 vs. 39%, p = 0.66). Cumulative meta-analyses indicated chronological stability for the pooled effect sizes of resection rate, 90-day mortality, major complications, and PHLF. Zhang et al. ALPPS for Colorectal Liver Metastases Conclusions: Compared with TSH, ALPPS for advanced CRLM resulted in superior surgical efficacy with comparable perioperative mortality rate and short-term oncological outcomes, while this was at the cost of increased perioperative minor complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Conventional Two-Stage Hepatectomy or Associating Liver Partitioning and Portal Vein Ligation for Staged Hepatectomy for Colorectal Liver Metastases? A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In this report, it became also apparent that CRC-MTS patients especially benefit from the ALPPS procedure. In addition to selection of the tumour entity, the liver parenchyma and any pretreatment play a relevant role [ 25 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Ligation of the middle hepatic vein to increase hypertrophy induction during the ALPPS procedure

Dondorf

Deeb

Bauschke

et al. 2021

Langenbecks Arch Surg

View full text Add to dashboard Cite

Purpose Here, we analyse the technical modification of the ALPPS procedure, ligating the middle hepatic vein during the first step of the operation to enhance remnant liver hypertrophy. Methods In 20 of 37 ALPPS procedures, the middle hepatic vein was ligated during the first step. Hypertrophy of the functional remnant liver volume was assessed in addition to postoperative courses. Results Volumetric analysis showed a significant volume increase, especially for patients with colorectal metastases. Pre-existing liver parenchyma damage (odds ratio = 0.717, p = 0.017) and preoperative chemotherapy were found to be significant predictors (odds ratio = 0.803, p = 0.045) of higher morbidity and mortality. In addition, a survival benefit for maintenance of middle hepatic vein was shown. Conclusion This technical modification of the ALPPS procedure can accentuate future liver remnant volume hypertrophy. The higher morbidity and mortality observed are most likely associated with pre-existing parenchymal damage within this group.

show abstract

“…Moreover, massive bleeding or repeated porta hepatis occlusion typically accompanies the classic 1st-stage operation, prolonging postoperative recovery. 13 14 Therefore, many surgeons believe that a balance between rapid FLR increase and trauma reduction in the 1st-stage operation is crucial for successful ALPPS. 15 In initial ALPPS practice, we strictly selected individuals only with normal liver condition, avoiding HBV-infected or liver cirrhosis, and although the short-term outcomes were satisfactory, the scope of ALPPS had remained restrained.…”

Section: Discussionmentioning

confidence: 99%

Modified Procedures for ALPPS Based on a Risk-Reduced Strategy: Paralleled Clinical Evaluation at Multiple Institutions

Kong¹,

Xing

et al. 2021

Yonsei Med J

View full text Add to dashboard Cite

Purpose We compared the clinical outcomes of modified procedures for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) based on a risk-reduced strategy with those of classic ALPPS procedures in treating large liver carcinoma. Materials and Methods Short-term outcomes, increases in future liver remnant (FLR) and functional FLR (FFLR), and overall survival (OS) were compared between 45 consecutive patients treated with modified ALPPS procedures and 34 patients treated with classic ALPPS procedures. Results Clinical outcomes after the 1st-stage operation markedly improved with the modified procedures. Although the proportions of liver cirrhosis and hepatocellular carcinoma were higher in the modified group, the mortality and incidence of severe complications did not increase. FLR and FFLR hypertrophy at 1 week after the 1st-stage operation were similar in both groups; however, kinetic growth rates in the modified group were lower. OS rates were similar. Conclusion Modified ALPPS procedures could be safely applied to provide long-term survival for patients with liver cirrhosis without sufficient FLR.

show abstract

Chance and challenge of associating liver partition and portal vein ligation for staged hepatectomy

Cited by 8 publications

References 61 publications

Conventional Two-Stage Hepatectomy or Associating Liver Partitioning and Portal Vein Ligation for Staged Hepatectomy for Colorectal Liver Metastases? A Systematic Review and Meta-Analysis

Conventional Two-Stage Hepatectomy or Associating Liver Partitioning and Portal Vein Ligation for Staged Hepatectomy for Colorectal Liver Metastases? A Systematic Review and Meta-Analysis

Ligation of the middle hepatic vein to increase hypertrophy induction during the ALPPS procedure

Modified Procedures for ALPPS Based on a Risk-Reduced Strategy: Paralleled Clinical Evaluation at Multiple Institutions

Contact Info

Product

Resources

About