Clinical evaluation of modified ALPPS procedures based on risk-reduced strategy for staged hepatectomy

Li, Jie; Yang, Guangsheng; Sun, Kai; Ma, Yan; Bi, Xiaowang

doi:10.1016/j.aohep.2020.08.063

Cited by 3 publications

(6 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hepatocellular carcinoma (HCC) represented the primary indication for surgery for a total 59 patients (49.6%) undergoing MI-ALPPS, included in three [ 18 , 20 , 21 ] of the selected studies, although 44 of them were part of a single center study from China [ 21 ]. Instead, colorectal liver metastasis (CRLM) represented the most common surgical indication for MI-ALPPS in four of the selected studies [ 16 , 17 , 18 , 19 ], for a total of 38 out of 45 patients (84.44%).…”

Section: Resultsmentioning

confidence: 99%

“…The estimated blood loss during two ALPPS stages was reported for 101 patients from four papers [ 17 , 18 , 19 , 21 ]. A total of three of them exclusively investigated a technical variant.…”

Section: Resultsmentioning

confidence: 99%

“…A total of three of them exclusively investigated a technical variant. In classic ALPPS [ 21 ], the range was 110–330 mL and 150–800 mL, in laparoscopic RALPPS [ 18 , 21 ] 20–480 mL and 80–280 mL, and 50–3200 mL and 350–960 mL, respectively, for Stage 1 and 2. The overall median that was observed was 260 mL in Stage 1 and 1625 mL in Stage 2.…”

Section: Resultsmentioning

confidence: 99%

“…The overall major morbidity was 8.14% in Stage 1, with 6 cases of biliary fistula requiring percutaneous drainage (Clavien–Dindo Grade IIIa) in the series by Jie et al [ 21 ]. The 90-day mortality was reported in one case after Stage 2 (0.8%) following severe peritonitis after mechanical ischemic obstruction of the small bowel.…”

Section: Resultsmentioning

confidence: 99%

“…Considering the whole MI-ALPPS series, major morbidity rate for Stage 1 was 8.14%, apparently lower than 11% that was reported for open ALPPS series [ 24 ], and 23.39% for Stage 2, surprisingly higher than 14.4% that was reported for open series [ 24 ]. This higher morbidity rate in MI-ALPPS cases could be related to the influence of series reported by Jie et al [ 21 ] which included HCC as the most frequent indication for surgery (44 patients which 8 Child–Pugh B) taking into account that, on the other side, the majority of the cases in open ALPPS series had been performed for CRLM.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Minimally Invasive ALPPS Procedure: A Review of Feasibility and Short-Term Outcomes

Cioffi¹,

Belli

Izzo

et al. 2023

Cancers

View full text Add to dashboard Cite

Background: Associated liver partition with portal vein ligation for staged hepatectomy (ALPPS) represents a recent strategy to improve resectability of extensive hepatic malignancies. Recent surgical advances, such as the application of technical variants and use of a mini-invasive approach (MI-ALPPS), have been proposed to improve clinical outcomes in terms of morbidity and mortality. Methods: A total of 119 MI-ALPPS cases from 6 series were identified and discussed to evaluate the feasibility of the procedure and short-term clinical outcomes. Results: Hepatocellular carcinoma were widely the most common indication for MI-ALPPS. The median estimated blood loss was 260 mL during Stage 1 and 1625 mL in Stage 2. The median length of the procedures was 230 min in Stage 1 and 184 in Stage 2. The median increase ratio of future liver remnant volume was 87.8%. The median major morbidity was 8.14% in Stage 1 and 23.39 in Stage 2. The mortality rate was 0.6%. Conclusions: MI-ALPPS appears to be a feasible and safe procedure, with potentially better short-term outcomes in terms of blood loss, morbidity, and mortality rate if compared with those of open series.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Minimally Invasive ALPPS Procedure: A Review of Feasibility and Short-Term Outcomes

Cioffi¹,

Belli

Izzo

et al. 2023

Cancers

View full text Add to dashboard Cite

show abstract

Efficacy of Technical Modifications to the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure

Khajeh

Ramouz

Moghadam

et al. 2022

Annals of Surgery Open

View full text Add to dashboard Cite

Objectives: To compare the outcomes of modified-Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) techniques with those of conventional-ALPPS. Background: ALPPS is an established technique for treating advanced liver tumors. Methods: PubMed, Web of Science, and Cochrane databases were searched. The outcomes were assessed by single-arm and 2-arm analyses. Results: Seventeen studies containing 335 modified-ALPPS patients were included in single-arm meta-analysis. The estimated blood loss was 267 ± 29 mL (95% confidence interval [CI], 210–324 mL) during the first and 662 ± 51 mL (95% CI, 562–762 mL) during the second stage. The operation time was 166 ± 18 minutes (95% CI, 131–202 minutes) during the first and 225 ± 19 minutes (95% CI, 188–263 minutes) during the second stage. The major morbidity rate was 14% (95% CI, 9%–22%) after the first stage. The future liver remnant hypertrophy rate was 65.2% ± 5% (95% CI, 55%–75%) and the interstage interval was 16 ± 1 days (95% CI, 14–17 days). The dropout rate was 9% (95% CI, 5%–15%). The overall complication rate was 46% (95% CI, 37%–56%) and the major complication rate was 20% (95% CI, 14%–26%). The postoperative mortality rate was 7% (95% CI, 4%–11%). Seven studies containing 215 patients were included in comparative analysis. The hypertrophy rate was not different between 2 methods (mean difference [MD], –5.01; 95% CI, –19.16 to 9.14; P = 0.49). The interstage interval was shorter for partial-ALPPS (MD, 9.43; 95% CI, 3.29–15.58; P = 0.003). The overall complication rate (odds ratio [OR], 10.10; 95% CI, 2.11–48.35; P = 0.004) and mortality rate (OR, 3.74; 95% CI, 1.36–10.26; P = 0.01) were higher in the conventional-ALPPS. Conclusions: The hypertrophy rate in partial-ALPPS was similar to conventional-ALPPS. This shows that minimizing the first stage of the operation does not affect hypertrophy. Moreover, the postoperative overall morbidity and mortality rates were lower following partial-ALPPS.

show abstract

Laparoscopic liver ALPPS - How I do it

Ciria,

Durán,

Calleja

et al. 2024

Mini-invasive Surg

View full text Add to dashboard Cite

In complex oncological liver resections, insufficient future liver remnant (FLR) volume may become the most challenging problem to deal with in the postoperative setting. The Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is one of the techniques described for inducing hepatic hypertrophy and achieving an adequate FLR. The technique initially described is performed by a complete bipartition of the liver in the first operation and a portal vein ligation to achieve occlusion of the intrahepatic circulation followed by a major hepatectomy in the second operation once an adequate FLR has been reached. With the introduction of minimally invasive liver surgery, these procedures can be performed by laparoscopic or robotic approach. We aim to provide a comprehensive overview of ALPPS, highlighting key technical aspects. Furthermore, the main aspects of this technique based on current evidence, such as indications, outcomes, strengths, limitations and potential complications, will be analyzed.

show abstract

Clinical evaluation of modified ALPPS procedures based on risk-reduced strategy for staged hepatectomy

Cited by 3 publications

References 21 publications

Minimally Invasive ALPPS Procedure: A Review of Feasibility and Short-Term Outcomes

Minimally Invasive ALPPS Procedure: A Review of Feasibility and Short-Term Outcomes

Efficacy of Technical Modifications to the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure

Laparoscopic liver ALPPS - How I do it

Contact Info

Product

Resources

About