Insight on ALPPS – Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy – mechanisms: activation of mTOR pathway

Uribe, Mario; Uribe-Echevarría, Sebastián; Mandiola, Carlos; Zapata, María Isabel Ferrer; Riquelme, F.; Romanque, Pamela

doi:10.1016/j.hpb.2018.02.636

Cited by 11 publications

(10 citation statements)

References 45 publications

(43 reference statements)

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“…The mechanism by which ALPPS promotes liver regeneration is not yet clear. Previous studies have indicated that it may be associated with changes in hepatic blood flow caused by the portal veins of the ligated hepatic lobe (41), the inflammatory response and stress response caused by disassociation of the liver or changes in proliferation-associated factors (17,42).…”

Section: Discussionmentioning

confidence: 99%

A preliminary study of associating liver partition and portal vein ligation for staged hepatectomy in a rat model of liver cirrhosis

et al. 2019

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Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in a rat model of liver cirrhosis has not, to the best of our knowledge, been previously investigated. The present study therefore aimed to establish a model of ALPPS in cirrhotic rats and to assess liver regeneration. Rats were randomly divided into an ALPPS group with carbon tetrachloride-induced cirrhosis (group A) and a normal liver (group B). Rat weight, cytokine levels, biochemical parameters and histopathology were assessed 1, 2, 3, 7 and 14 days after ALPPS. Higher aspartate aminotransferase and alanine aminotransferase levels were detected in group A on the first postoperative day. On the first, second and third days, hepatocyte proliferation rate was higher in group B than in group A. After 3 days, hepatocyte proliferation rate in group B began to decrease, but the rate in group A continued to increase until the 14th day. Higher levels of hepatocyte growth factor, interleukin-6 and tumor necrosis factor-α were detected in group A compared with group B, but the differences were not significant. The present study demonstrated that ALPPS promoted liver regeneration in a rat model of cirrhosis, but significantly impaired liver function. Compared with the ALPPS model, group B exhibited a delayed peak of proliferation. The mechanism of liver regeneration induced by ALPPS in cirrhotic rats may be associated with increased cytokine levels.

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Section: Discussionmentioning

confidence: 99%

A preliminary study of associating liver partition and portal vein ligation for staged hepatectomy in a rat model of liver cirrhosis

et al. 2019

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“…Forty-one patients with NET requiring the ALPPS approach have been published so far (http://fp.amegroups. cn/cms/ef5b8bf3a11b76b474fa9762e46828a7/hbsn-20-355-3.docx) (22,27,28,(32)(33)(34)(35)(36)(37)(38)(39). In all the patients but one, the treatment was done for hepatic NET metastases.…”

Section: Alpps Cases In Net Patientsmentioning

confidence: 99%

Uncommon indications for associating liver partition and portal vein ligation for staged hepatectomy: a systematic review

Lai¹,

Mennini²,

Laureiro³

et al. 2021

Hepatobiliary Surg Nutr

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Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) represents an innovative surgical technique used for the treatment of large hepatic lesions at high risk for post-resection liver failure due to a small future liver remnant. The most significant amount of literature concerns the use of ALPPS for the treatment of hepatocellular carcinoma (HCC), cholangiocarcinoma (CCC), and colorectal liver metastases (CRLM). On the opposite, few is known about the role of ALPPS for the treatment of uncommon liver pathologies. The objective of the present study was to evaluate the current literature on this topic. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible articles published up to February 2020 were included using the MEDLINE, Scopus, and Cochrane databases. Among the 486 articles screened, 45 papers met the inclusion criteria, with 136 described cases of ALPPS for rare indications. These 136 cases were reported in 18 different countries. Only in two countries, namely Germany and Brazil, more than ten cases were observed. As for the ALPPS indications, we reported 41 (30.1%) cases of neuroendocrine tumor (NET) metastases, followed by 27 (19.9%) cases of gallbladder cancer (GBC), nine (6.6%) pediatric cases, six (4.4%) gastrointestinal stromal tumors, six (4.4%) adult cases of benign primary liver disease, four (2.9%) adult cases of malignant primary liver disease, and 43 (31.6%) adult cases of malignant secondary liver disease.According to the International ALPPS Registry data, less than 10% of the ALPPS procedures have been performed for the treatment of uncommon liver pathologies. NET and GBC are the unique pathologies with acceptable numerosity. ALPPS for NET appears to be a safe procedure, with satisfactory long-term results. On the opposite, the results observed for the treatment of GBC are poor. However, these data should be considered with caution. The rationale for treating benign pathologies with ALPPS appears to be weak.No definitive response should be given for all the other pathologies. Multicenter studies are needed with the intent to clarify the potentially beneficial effect of ALPPS for their treatment.

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“…Our analysis showed that pretreatment with chemotherapy and liver parenchyma damage significantly reduce hypertrophy. Nevertheless, further studies are needed, particularly regarding liver regeneration within the setting of ALPPS after chemotherapy [ 33 , 34 ].…”

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

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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.

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Insight on ALPPS – Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy – mechanisms: activation of mTOR pathway

Abstract: Rapid liver regeneration with ALPPS might be associated with hepatocyte proliferation induced by mTOR pathway activation.

Cited by 11 publications

References 45 publications

A preliminary study of associating liver partition and portal vein ligation for staged hepatectomy in a rat model of liver cirrhosis

A preliminary study of associating liver partition and portal vein ligation for staged hepatectomy in a rat model of liver cirrhosis

Uncommon indications for associating liver partition and portal vein ligation for staged hepatectomy: a systematic review

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

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