Impact of Neoadjuvant Chemotherapy on Hypertrophy of the Future Liver Remnant after Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy

Kremer, Michael; Manzini, Giulia; Hristov, Branimir; Polychronidis, Georgios; Mokry, Theresa; Sommer, Christoph; Mehrabi, Arianeb; Weitz, Jürgen; Büchler, Markus W.; Schemmer, Peter

doi:10.1016/j.jamcollsurg.2015.05.017

Cited by 40 publications

(29 citation statements)

References 57 publications

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“…This difference is still difficult to explain but may be attributed to a systemic response to the additional parenchymal transection. Apparently, the degree of hypertrophy observed after ALPPS step 1 does not seem to be hampered by preoperative chemotherapy, but data are controversial [44, 53, 54]. Similarly, data regarding proliferation indices (Ki67 index) are contradictory in literature.…”

mentioning

confidence: 99%

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

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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.

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mentioning

confidence: 99%

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

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“…Perioperative morbidity and mortality was reduced after implementing LiMAx algorithms in LRs,47 and after LT the LiMAx score was predictive for postoperative liver failure. However, so far LiMAx has not been recognised in any of the guidelines for treatment of HCC or LT. Also, new innovations in liver surgery like portal vein embolisation,48 two-stage hepatectomy,49 Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS)50 or partial ALPPS51 allow extensive LR with acceptable morbidity and mortality, even when transplantation because of tumour load is no option anymore. However, extended LR can only be performed in healthy liver, thus again leaving transplantation as only potential curative treatment.…”

Section: Discussionmentioning

confidence: 99%

Is there a standard for surgical therapy of hepatocellular carcinoma in healthy and cirrhotic liver? A comparison of eight guidelines

Manzini

Henne‐Bruns

Porzsolt

et al. 2017

BMJ Open Gastroenterol

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Background and aimsLiver resection (LR) and transplantation are the most reliable treatments for hepatocellular carcinoma (HCC). Aim was to compare different guidelines regarding indication for resection and transplantation because of HCC with and without underlying cirrhosis.MethodsWe compared the following guidelines published after 1 January 2010: American (American Association for the Study of Liver Diseases (AASLD)), Spanish (Sociedad Espanola de Oncologia Medica (SEOM)), European (European Association for the study of liver-European Organization for Research and Treatment of Cancer (EASL-EORTC) and European Society for Medical Oncology-European Society of Digestive Oncology (ESMO-ESDO)), Asian (Asian Pacific Association for the Study of Liver (APASL)), Japanese (Japan Society of Hepatology (JSH)), Italian (Associazione Italiana Oncologia Medica (AIOM)) and German (S3) guidelines.ResultsAll guidelines recommend resection as therapy of choice in healthy liver. Guidelines based on the Barcelona Clinic Liver Cancer staging system recommend resection for single HCC<2 cm and Child-Pugh A cirrhosis and for HCC≤5 cm with normal bilirubin and portal pressure, whereas transplantation is recommended for multiple tumours between Milan criteria and for single tumours ≤5 cm and advanced liver dysfunction. Patients with HCC and Child-Pugh C cirrhosis are not candidates for transplantation. JSH guidelines recommend LR for patients with Child-Pugh A/B with HCC without tumour size restriction; APASL guidelines in general exclude patients with Child-Pugh A from transplantation. In patients with Child-Pugh B, transplantation is the second-line therapy, if resection is not possible for patients within Milan criteria. German and Italian guidelines recommend transplantation for all patients within Milan criteria.ConclusionsWhereas resection is the standard therapy of HCC in healthy liver, a standard regarding the indication for LR and transplantation for HCC in cirrhotic liver does not exist, although nearly all guidelines claim to be evidence based. Surprisingly, despite European guidelines, Germany and Italy use their own national guidelines which partially differ from the European. Possible solutions of the problems are discussed.

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“…Schnitzbauer et al reported procedure‐related mortality of 12%, and 28% of patients developed severe complications. Subsequent ALPPS series by other groups reported high 90‐day mortality rates up to 20% . This unfavorable safety profile of ALPPS has led to skepticism in the pioneer phase of this procedure and even some experienced hepatobiliary centers stopped performing this procedure.…”

Section: The Basic Principles Of Associating Liver Partition and Portmentioning

confidence: 99%

“…Subsequent ALPPS series by other groups reported high 90-day mortality rates up to 20%. [14][15][16][17][18][19][20] This unfavorable safety profile of ALPPS has led to skepticism in the pioneer phase of this procedure and even some experienced hepatobiliary centers stopped performing this procedure. Over time, various risk factors for procedure-related morbidity and mortality have been identified and the perioperative outcome of ALPPS has significantly improved.…”

Section: The Basic Principles Of Associating Liver Partition and Pomentioning

confidence: 99%

Dealing with insufficient liver remnant: Associating liver partition and portal vein ligation for staged hepatectomy

Linecker

Kuemmerli

Clavien

et al. 2019

Journal of Surgical Oncology

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Liver resection for colorectal liver metastases has emerged to highly successful treatment in the last decades. Key to this success is complete hepatic tumor removal and systemic disease control by chemotherapy. Associating liver partition and portal vein ligation for staged hepatectomy is the most recent two‐stage resection strategy for patients with very small future liver remnant making complete tumor removal possible within 1 to 2 weeks. Oncological outcome data are being collected at the moment and first results from small series reveal promising results.

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Impact of Neoadjuvant Chemotherapy on Hypertrophy of the Future Liver Remnant after Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy

Cited by 40 publications

References 57 publications

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

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

Is there a standard for surgical therapy of hepatocellular carcinoma in healthy and cirrhotic liver? A comparison of eight guidelines

Dealing with insufficient liver remnant: Associating liver partition and portal vein ligation for staged hepatectomy

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