The ALPPS Approach: Should We Sacrifice Basic Therapeutic Rules in the Name of Innovation?

Figueras, Joan; Belghiti, Jacques

doi:10.1007/s00268-014-2540-0

Cited by 11 publications

(5 citation statements)

References 6 publications

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“…This technique, named Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), has been demonstrated to induce rapid and extensive hypertrophy and has challenged the concept of unresectability [16,17]. However, much controversy has surrounded this procedure, and both safety and long-term oncologic outcomes have been questioned [18,19].…”

Section: Introductionmentioning

confidence: 97%

ALPPS: Challenging the concept of unresectability – A systematic review

Bertens

Hawel

Lung

et al. 2015

International Journal of Surgery

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Section: Introductionmentioning

confidence: 97%

ALPPS: Challenging the concept of unresectability – A systematic review

Bertens

Hawel

Lung

et al. 2015

International Journal of Surgery

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“…6 The first analysis of the international registry reported that the rate of post-operative liver failure by 50-50 criteria is 9% after either the first or second stage of ALPPS. 6 This has led to calls for caution from experienced liver centers 15,16 and controversial discussions at recent hepatobiliary meetings.…”

Section: Introductionmentioning

confidence: 99%

The many faces of ALPPS: surgical indications and techniques among surgeons collaborating in the international registry

Buac

Schadde

Schnitzbauer³

et al. 2016

HPB

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Background: ALPPS was developed to induce accelerated future liver remnant (FLR) hypertrophy in order to increase hepatic tumour resectability and reduce the risk of post-operative liver failure. While early studies demonstrated concerning complication rates, others reported favourable results. This inconsistency may be due to variability in surgical indications and technique. Methods: A web-based survey was sent to surgeons participating in the International ALPPS Registry in September of 2014. Questions addressed surgeon demographics and training, surgical indications and technique, and clinical management approaches.Results: Fifty six out of 85 surgeons from 78 centers responded (66%) and half (n = 30) had training in liver transplantation. Forty seven (84%) did not reserve ALPPS solely for colorectal liver metastases (CRLM) and 30 (54%) would perform ALPPS for an FLR over 30%. Neoadjuvant chemotherapy for CRLM was recommended by 37 (66%) respondents. Surgical approaches varied considerably, with 30% not preserving outflow to the middle hepatic vein and 39% believing it necessary to skeletonize the hepatoduodenal ligament. Twenty five (45%) surgeons have observed segment 4 necrosis. Conclusion:There is considerable variability in how ALPPS is performed internationally. This heterogeneity in practice patterns may explain the current incongruity in published outcomes, and highlights the need for standardization.

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“…The ALPPS procedure created tremendous interest among liver surgeons because of the pace of liver regeneration that it allowed, enabling completion of the two stages of liver resection within 9 to 11 days. The procedure has yet to be widely adopted mainly due to concerns with increasing morbidity, mortality10 and potentially higher recurrence rates 1112…”

Section: Introductionmentioning

confidence: 99%

Partial ALPPS with a longer wait between procedures is safe and yields adequate future liver remnant hypertrophy

Kumar

Duncan

O’Reilly

et al. 2019

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has generated controversy due to high morbidity and mortality. We present our series of patients with 30–40% parenchymal transection and minimal hilar dissection. Methods Patients who had partial ALPPS between April 2015 and April 2016 were included. Patients with colorectal liver metastases (CRLM) had their future liver remnants (FLR) cleared with metastasectomies. The liver was divided along the future line of transection to 30–40%, right portal vein was stapled and divided without extensive hilar dissection, with minimal handling of right liver, which was not mobilised. We preserved the middle hepatic vein. Data were collected prospectively for hypertrophy of the FLR, morbidity and mortality. Results Among the 8 patients (age 25–68) investigated, one patient with cholangiocarcinoma had portal vein embolization prior to partial ALPPS. All patients completed two stages with adequate FLR hypertrophy at a median of 28 days. No mortality was found. The median length of stay after stages 1 and 2 was 9 and 9.6 days, respectively. The median increase in FLR was 38%. Conclusions A limited transection of 30–40%, minimal hilar dissection and longer wait between stages yielded adequate FLR hypertrophy with low morbidity and no mortality.

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The ALPPS Approach: Should We Sacrifice Basic Therapeutic Rules in the Name of Innovation?

Cited by 11 publications

References 6 publications

ALPPS: Challenging the concept of unresectability – A systematic review

ALPPS: Challenging the concept of unresectability – A systematic review

The many faces of ALPPS: surgical indications and techniques among surgeons collaborating in the international registry

Partial ALPPS with a longer wait between procedures is safe and yields adequate future liver remnant hypertrophy

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