The ALPPS Procedure: A Surgical Option for Hepatocellular Carcinoma with Major Vascular Invasion

Vennarecci, Giovanni; Laurenzi, Andrea; Santoro, Roberto; Colasanti, Marco; Lepiane, Pasquale; Ettorre, Giuseppe Maria

doi:10.1007/s00268-013-2296-y

Cited by 52 publications

(46 citation statements)

References 34 publications

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“…The procedure is consisted of two-staged hepatectomy by which rapid significant hypertrophy of the remnant is induced by transecting the parenchyma while there is not enough time for the development of collateral formation. [10111213141516] The technique is relied on portal vein ligation and in situ splitting through parenchyma so that the two parts are just connected through hilar structures in the first step. Partitioning will be completed after an interval of 7 days if FLR hypertrophy is satisfactory.…”

Section: Discussionmentioning

confidence: 99%

“…Partitioning will be completed after an interval of 7 days if FLR hypertrophy is satisfactory. [1316] There are promising results on remnant growth rate by ALPPS procedure in literature. [1718] But the reason that the technique is not approved yet is lack of being evaluated technically in early development phase till now.…”

Section: Discussionmentioning

confidence: 99%

“…[1718] But the reason that the technique is not approved yet is lack of being evaluated technically in early development phase till now. [1619]…”

Section: Discussionmentioning

confidence: 99%

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Associating liver partition and portal vein ligation for staged hepatectomy: A surgical technique for liver resections

et al. 2017

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Background:Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel surgical technique liver resection in traditionally nonresectable primary intrahepatic tumors or colorectal liver metastases.Materials and Methods:From June 2013 to March 2014, patients with primary tumor of liver or colorectal tumors with liver metastasis were selected to evaluate whether they met the initial criteria for ALPPS procedure.Results:Nine patients enrolled in the study with primary diagnoses of colon and rectosigmoid cancer, carcinoid tumor, gastrointestinal stromal tumor of small intestine, hepatocellular carcinoma, and pancreatic neuroendocrine tumor (PNET). Four candidates excluded from the study prior or during the first step operation due to fatty liver, hepatic fibrosis, peritoneal seeding, and multiple small intestine metastases. Five patients underwent two stages of ALPPS with the interval of about 1 week. Liver hypertrophy was 100% among our candidates after the initial step. One postoperative death happened because of massive pulmonary thromboembolism Recurrence of liver metastasis was seen in one patient. Hepatic failure Class B and A were observed in two patients which did not progress during follow-up period. One patient developed an enterocutaneous fistula.Discussion:We recommend to use 2 organ bags, one for wrapping right lobe and the other one for covering visceral organs and also do liver biopsy in suspicious cases of damaged liver parenchyma and laparoscopic exploration of abdomen for seeding and multiple metastases prior to laparotomy.Conclusion:As the procedure has not been well established and verified by oncologists yet, further studies are required to define the exact indications of ALPPS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Associating liver partition and portal vein ligation for staged hepatectomy: A surgical technique for liver resections

et al. 2017

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“…For resectable HCC ruptures, emergency hepatectomy or staged hepatectomy after transcatheter arterial embolization (TAE) are life-saving procedures, and efficient therapeutic methods (3). Associating liver partition and portal vein ligation (ALPPS) for HCC has been reported to be safe even in patients with portal vein tumor thrombosis (PVTT) (4,5).…”

Section: Introductionmentioning

confidence: 99%

Associating liver partition and portal vein ligation for bleeding hepatocellular carcinoma in HBV cirrhosis: a safety strategy

Sandri

Vennarecci

Lepiane

et al. 2017

Transl. Gastroenterol. Hepatol.

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The incidence of hepatocellular carcinoma (HCC) spontaneous tumor rupture varies between 3% and 26%. For resectable HCC ruptures, emergency hepatectomy or staged hepatectomy after transcatheter arterial embolization (TAE) are life-saving procedures, and efficient therapeutic methods. We report a multimodal therapy including TAE, associating liver partition and portal vein ligation (ALPPS) and immunoglobuline infusion for a huge bleeding HCC with portal vein tumor thrombosis (PVTT) in hepatitis B virus (HBV) cirrhosis. ALPPS first step began with an abdominal toilette due to the massive hemoperitoneum and a portal vein incision at the bifurcation of the right and left portal veins was performed.A freely floating left part of the thrombus was extracted from the left portal vein in order to restore the left portal vein. The right portal vein with complete thrombosis was closed. Liver partition was then performed. The second step was performed without complications. A HCC Edmondson grade 4 (pT3b) and a cirrhotic liver parenchyma were described. Postoperative ascites decompensation was treated and patient was discharged in postoperative day 21. The reported triple strategy allowed us to prolong patient live. A multimodal therapy including TAE, ALPPS and immunoglobuline is a good option for a life treatment in case of huge bleeding hepatocellular carcinoma with PVTT in HBV cirrhosis.

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“…Second, adding parenchymal transection would allow triggering liver regeneration in the future liver remnant when other classical strategies are likely to be ineffective. Hence, this strategy would appear relevant for patients with portal vein thrombosis, as recently suggested [1]. It has been almost two years since the pioneering publication of Schnitzbauer et al [2] describing their breakthrough surgical strategy, and many centers around the world have since reported their own experience.…”

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confidence: 96%

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

Figueras

Belghiti

2014

World j. surg.

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The ALPPS Procedure: A Surgical Option for Hepatocellular Carcinoma with Major Vascular Invasion

Abstract: This novel strategy could expand the number of patients undergoing major liver resections that were previously considered non-resectable because of the risk of liver decompensation for an insufficient FLR.

Cited by 52 publications

References 34 publications

Associating liver partition and portal vein ligation for staged hepatectomy: A surgical technique for liver resections

Associating liver partition and portal vein ligation for staged hepatectomy: A surgical technique for liver resections

Associating liver partition and portal vein ligation for bleeding hepatocellular carcinoma in HBV cirrhosis: a safety strategy

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

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