Technical modifications and outcomes after Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) for primary liver malignancies: A systematic review

Mpaili, Eustratia; Tsilimigras, Diamantis I.; Moris, Demetrios; Sahara, Kota; Pawlik, Timothy M.

doi:10.1016/j.suronc.2020.01.010

Cited by 24 publications

(24 citation statements)

References 56 publications

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“…Considering that patients with colorectal cancer can benefit from an ALPPS procedure and that the modification with respect to hypertrophy was significant in this patient group, it is obvious that patient selection is of enormous importance, which has already been demonstrated by other research groups [ 29 – 31 ]. In this report, it became also apparent that CRC-MTS patients especially benefit from the ALPPS procedure.…”

Section: Discussionmentioning

confidence: 75%

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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Section: Discussionmentioning

confidence: 75%

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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“… 20 Hepatobiliary scintigraphy using 99mTc-labeled iminodiacetic acid derivates could show that volumetry overestimates liver function in ALPPS. 20 21 The mechanisms of the discrepancy between volume increase and the high rate of liver failure in ALPPS are not fully understood and may be attributed to initial edema and enlarged, but still at least partially immature and not completely functioning hepatocytes, within the initial period of regeneration. 22 This warranted an assessment of both function and volume of the FLR during the interstage course of ALPPS.…”

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

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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.

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“…Описано 1 наблюдение, в котором эта операция была выполнена лапароскопически [28]. В то же время у пациентов с ГЦК и ЦП на 2020 г. не было описано ни одного обратного ALPPS [29]. В нашем центре из 34 выполненных ALPPS это клиническое наблюдение является единственным.…”

Section: вве де ниеunclassified

“Reversal” ALPPS in patient with hepatocellular carcinoma and liver cirrhosis. First clinical case in Russia

et al. 2021

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Liver resection in patients with HCC is the treatment of choice. In patients with insufficient future liver remnant (FLR) and compensated liver function performing the Associated Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is possible. The classic version of ALPPS consists in ligation of the right branch of the portal vein with transection of the parenchyma and then performing right hepatectomy or right trisegmentectomy. This paper describes the first case in Russia of performing ligation of the left portal branch with transection of the parenchyma and then performing left trisegmentectomy (“reversal” ALPPS) in a patient with HCC and cirrhosis. Reversal ALPPS can be successfully performed in patients with insufficient future liver remnant in well-selected patients.

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Technical modifications and outcomes after Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) for primary liver malignancies: A systematic review

Cited by 24 publications

References 56 publications

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

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

“Reversal” ALPPS in patient with hepatocellular carcinoma and liver cirrhosis. First clinical case in Russia

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