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A new strategy in the surgical treatment of multiple liver tumors – ALPPS


Authors: M. Peteja 1,2,3 ;  L. Martínek 2,3 ;  M. Mazur 2,3;  P. Vávra 2,3;  P. Zonča 2,3;  V. Janout 1
Authors place of work: Ústav epidemiologie a ochrany veřejného zdraví, Lékařská fakulta Ostravské univerzity v Ostravě vedoucí ústavu: Prof. MUDr. V. Janout, CSc. 1;  Chirurgická klinika, FN Ostrava, přednosta: Doc. MUDr. P. Zonča, Ph. D., FRCS 2;  Katedra chirurgických oborů, Lékařská fakulta Ostravské univerzity v Ostravě vedoucí katedry: Doc. MUDr. P. Zonča, Ph. D., FRCS 3
Published in the journal: Rozhl. Chir., 2014, roč. 93, č. 6, s. 301-306.
Category: Review

Summary

Introduction:
This systematic review was performed to introduce the two-staged hepatectomy procedure (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy - ALPPS) and present its current results.

Material and methods:
We conducted a systematic literature search using the PubMed database with key words “ALPPS” or “staged liver resection”. The inclusion criteria were randomized trials or cohort studies. Case reports were excluded. The primary end-point was the assessment of liver tissue hypertrophy after the ALPPS procedure. Morbidity and mortality evaluation were the secondary end-point.

Results:
After an electronic data search of PubMed with the selected key words, six cohort studies evaluating 96 patients met the inclusion criteria. There was no prospective randomised trial. Based on the results of the individual studies, liver hypertrophy ranged from 74 to 87%. Morbidity and mortality ranged from 53 to 71% and 0 to 13% respectively.

Conlcusions:
Despite the higher morbidity and mortality the ALPPS procedure could be a promising technique for a selected group of patients with multiple liver tumors. However long term results are not yet available.

Key words:
ALPPS – liver hypertrophy – portal vein ligation- liver resection – multiple liver metastases


Zdroje

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3. Adam, R, Laurent A, Azoulay D, Casting D, Bismuth H, et al. Two-stage hepatectomy: A planned strategy to treat irresectable liver tumors. Ann Surg 2000;232:777–785.

4. Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, et al. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 2004;240:1037–1051.

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13. Narita M, Oussoultzoglou E, Ikai I, Bachellier P, Jaeck D. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 2012;256:e7–8; author reply e16–7.

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16. Machado MA, Makdissi FF, Surjan RC. Totally laparoscopic ALPPS is feasible and may be worthwhile. Ann Surg 2012;256:e13; author reply e16–9.

17. Aloia TA, Vauthey JN. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): what is gained and what is lost? Ann Surg 2012;256:e9; author reply e16–9.

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20. Tschuor Ch, Sergeant G, Schadde E, Slankamenac K, Clavien PA, et. al. Salvage parenchymal liver transection for patients with insufficient volume increase after portal vein occlusion? An extension of the ALPPS approach. Europ J Surg Oncol 2013;39: 1230–1235.

21. Jain HA, Bharathy KG, Negi SS. Associating liver partition and portal vein ligation for staged hepatectomy: will the morbidity of an additional surgery be outweighed by better patient outcomes in the long-term? Ann Surg 2012;256:e10; author reply e16–7.

22. Torres OJ, Moraes-Junior JM, Lima NC, Moraes AM. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): a new approach in liver resections. Arq Bras Cir Dig 2012;25:290–292.

23. Maroulis I, Karavias DD, Karavias D. General principles of hepatectomy in colorectal liver metastases. Tech Coloproctol 2012;15:S13.

24. Cavaness KM, Doyle MB, Lin Y, Maynard E, Chapman WC. Using ALPPS to induce rapid liver hypertrophy in a patient with hepatic fibrosis and portal vein thrombosis. J Gastrointest Surg 2013;17:207–12.

25. Sala S, Ardiles V, Ulla M, Alvarez F, Pekolj J, et a. Our initial experience with ALPPS technique: encouraging results. Updates Surg 2012;64:167–72.

26. Yokoyama Y, Nagino M, Nimura Y. Mechanisms of hepatic regeneration following portal vein embolization and partial hepatectomy: a review. World J Surg 2007;31:367–374.

27. Robles R, et al. Comparative study of right portal vein ligation versus embolisation for induction of hypertrophy in two-steged hepatectomy for multiple bilateral colorectal liver metastases, Eur J Surg Oncol 2012; 38:586–593.

Štítky
Surgery Orthopaedics Trauma surgery

Článok vyšiel v časopise

Perspectives in Surgery

Číslo 6

2014 Číslo 6
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