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ALPPS procedure

Alexandra Dili, Valérie Lebrun, Claude Bertrand, Isabelle A Leclercq
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows extended hepatectomy in patients with an extremely small future liver remnant (FLR). Current rodent models of ALPPS do not include resection resulting in insufficient-for-survival FLR, or they do incorporate liver mass reduction prior to ALPPS. Differences in FLR volume and surgical procedures could bias our understanding of physiological and hemodynamic mechanisms. We aimed to establish a rat ALPPS model with minimal FLR without prior parenchymal resection...
January 21, 2019: Laboratory Investigation; a Journal of Technical Methods and Pathology
Erik Schadde, Boris Guiu, Rebecca Deal, Jennifer Kalil, Bulent Arslan, Jordan Tasse, Pim B Olthof, Jan Heil, Andreas A Schnitzbauer, Shriram Jakate, Stefan Breitenstein, Martin Schläpfer, Beatrice Beck Schimmer, Martin Hertl
BACKGROUND: Liver hypertrophy induced by partial portal vein occlusion (PVL) is accelerated by adding simultaneous parenchymal transection ("ALPPS procedure"). This preclinical experimental study in pigs tests the hypothesis that simultaneous ligation of portal and hepatic veins of the liver also accelerates regeneration by abrogation of porto-portal collaterals without need for operative transection. METHODS: A pig model of portal vein occlusion was compared with the novel model of simultaneous portal and hepatic vein occlusion, where major hepatic veins draining the portal vein-deprived lobe were identified with intraoperative ultrasonography and ligated using pledgeted transparenchymal sutures...
October 25, 2018: Surgery
Michael Linecker, Christoph Kuemmerli, Patryk Kambakamba, Andrea Schlegel, Paolo Muiesan, Ivan Capobianco, Silvio Nadalin, Orlando J Torres, Arianeb Mehrabi, Gregor A Stavrou, Karl J Oldhafer, Georg Lurje, Deniz Balci, Hauke Lang, Ricardo Robles-Campos, Roberto Hernandez-Alejandro, Massimo Malago, Eduardo De Santibanes, Pierre-Alain Clavien, Henrik Petrowsky
BACKGROUND: Based on the International ALPPS registry, we have recently proposed two easily applicable risk models (pre-stage1 and 2) for predicting 90-day mortality in ALPPS but a validation of both models has not been performed yet. METHODS: The validation cohort (VC) was composed of subsequent cases of the ALPPS registry and cases of centers outside the ALPPS registry. RESULTS: The VC was composed of a total of 258 patients including 70 patients outside the ALPPS registry with 32 cases of early mortalities (12%)...
November 23, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Jinwei Zhao, Hongyue Xu, Yuan Li, Lulu Gong, Ge Zheng, Xuefei Wang, Wenjin Luan, Shulin Li, Fangxue Ma, Lihui Ni, Xudong Tang, Xueyan Wang, Lu Yu
BACKGROUND: Associating liver partition and portal vein ligation (ALPPS) is a promising two-step hepatectomy that is beneficial for accumulative regeneration of the future liver remnant (FLR) and avoids postoperative liver failure. AIMS: Our study aimed to evaluate whether nonalcoholic fatty liver disease affected the liver regeneration induced by ALPPS. METHODS: Sprague-Dawley rats fed a high-fat diet were used to construct the NAFLD model...
November 23, 2018: Digestive Diseases and Sciences
Eduardo de Souza Martins Fernandes, Felipe Pedreira Tavares de Mello, Ronaldo Oliveira Andrade, Camila Liberato Girao, Leandro Savattone Pimentel, Camilla Cesar, Claudia Cristina Sousa, Anderson Brito-Azevedo, Samanta Teixeira Basto, Orlando Jorge Martins Torres
BACKGROUND The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an important tool to induce fast liver hypertrophy. The degree of hepatic fibrosis/cirrhosis in patients with HCC negatively impacts their health, and the risk of liver failure is always present. In these cases, liver transplantation may be necessary as a rescue procedure. We present the case of a patient with HCC who underwent ALPPS and developed liver failure. A living donor liver transplant was performed as a rescue procedure...
November 9, 2018: American Journal of Case Reports
Alexander Ferko, Martin Vojtko, Marek Adámik, Ľudovít Laca, Dagmar Sudeková, Dagmar Šuteková, Marek Smolár
BACKGROUND: A laparoscopic approach for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) would have the potential to decrease morbidity and mortality rates,1 as similarly observed with laparoscopic liver surgery.2 METHODS: A 54-year-old woman with stage IV rectal cancer (cT3dN1M1) was indicated for the 'liver-first' approach. The patient presented with a massive bilobar metastatic liver involvement, including S4. Five lesions were localized in a small left liver lobe (future liver remnant < 25%)...
October 29, 2018: Annals of Surgical Oncology
Arezou Abbasi, Amir A Rahnemai-Azar, Katiuscha Merath, Sharon M Weber, Daniel E Abbott, Mary Dillhoff, Jordan Cloyd, Timothy M Pawlik
Colorectal carcinoma (CRC) is the third leading cause of cancer-related death in the United States. The liver is the most frequent site of metastasis and a key determinant of survival in patients with isolated colorectal liver metastasis (CRLM). Surgical resection remains the only hope for prolonged survival in patients with CRLM. However, most patients are deemed to be unresectable at presentation due to a small future liver remnant (FLR) and fear of post-hepatectomy liver failure. Procedures such as portal vein ligation or embolization (PVL/PVE) followed by hepatectomy have been established as standard methods to increase FLR volume, but have limitations dependent upon extent of disease and patient's ability to grow the liver remnant...
2018: Translational Gastroenterology and Hepatology
Moritz Schmelzle, Robert Öllinger, Bernhard Gebauer, Petr Podrabsky, Johann Pratschke
OBJECTIVE: After recent evaluations of the ALPPS registry, with perioperative results sobering in particular for central bile duct carcinomas, the initial euphoria for this procedure disappeared. It is thus desirable to modify the concept of reducing the invasiveness and high complication rate of the procedure. INDICATIONS: Below we report a 72-year-old female patient with a gallbladder carcinoma locally infiltrating and metastatic to segments 4 b and 5. Due to a too small future liver remnant volume of segments 1 - 3 before planned extended right hemihepatectomy, we planned a laparoscopic partial PVE-ALPPS for hypertrophy induction...
October 22, 2018: Zentralblatt Für Chirurgie
Federico Tomassini, Yves D'Asseler, Mariano C Giglio, Clarisse Lecluyse, Bieke Lambert, Mauricio Sainz-Barriga, Jo Van Dorpe, Anne Hoorens, Karen Geboes, Roberto I Troisi
BACKGROUND: Excessive increase of portal flow and pressure following extended hepatectomy have been associated to insufficient growth or function of the future liver remnant (FLR), with the risk of post-hepatectomy liver failure (PHLF). We prospectively assess the influence of liver hemodynamics on FLR regeneration and function in Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS). METHODS: Twenty-three patients underwent ALPPS; liver hemodynamics were assessed throughout the procedures...
October 9, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Giovanni Vennarecci, Daniele Ferraro, Antonella Tudisco, Giovanni Battista Levi Sandri, Nicola Guglielmo, Giammauro Berardi, Isabella Sperduti, Giuseppe Maria Ettorre
The ALPPS is a technique that allows achieving hepatic resection by a rapid future liver remnant hypertrophy. The aim of this study was to report the experience of an Italian center with ALPPS in patients with liver tumors. A retrospective analysis of patients undergoing ALPPS between 2012 and 2017 was performed. Patients' characteristics and disease presentation, increase in future liver remnant (FLR) as well as intraoperative and postoperative short- and long-term outcomes were evaluated. A total of 24 patients underwent the ALPPS procedure: 17 procedures for hepatocarcinoma (HCC), 5 for colorectal liver metastases (CRLM), 1 for cholangiocarcinoma (CC) and 1 for Merkel Cell Carcinoma liver metastasis (MCCLM)...
September 25, 2018: Updates in Surgery
Tong Yifan, Xu Ming, Wang Yifan, Ying Hanning, Jiang Guangyi, Yan Peijian, Wu Ke, Cai Xiujun
BACKGROUND: The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure promotes the proliferation of the future liver remnant, but evidence to support the feasibility of ALPPS in livers with fibrosis is needed. Therefore the aim of this study was to establish a fibrotic ALPPS model in the rat to compare the capacity of regeneration in the remnant liver with or without fibrosis. METHODS: In our study we first established a thioacetamide-induced fibrotic ALPPS model in rats...
September 21, 2018: Surgery
Chao Qu, Lin-Lin Qu, Cheng-Zhan Zhu, Zu-Sen Wang, Jingyu Cao
RATIONALE: Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare and are difficult to diagnose preoperatively.We report a case of PHNET diagnosed preoperatively and successfully resected using associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). PATIENT CONCERNS: A 72-year-old woman was admitted to our hospital for a hepatic mass, which was incidentally identified during a routine health checkup. The patient has no other obvious symptoms of discomfort...
September 2018: Medicine (Baltimore)
Marcel C C Machado, Emerson S Abe, Rodrigo Dumarco, Públio Viana, Marcel Autran C Machado
RATIONALE: The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure is a recently introduced treatment strategy for patients with advanced primary or metastatic liver tumors and small future liver remnants. ALPPS procedure using ischemic bipartition of the liver is a modified technique that may reduce complications compared to classical ALPPS. PATIENT CONCERNS: Two patients with multiple colorectal liver metastasis with extensive involvement of the liver were considered unresectable before treatment because of small future liver remnant (FLR)...
August 2018: Medicine (Baltimore)
Francisco Tustumi, Lucas Ernani, Fabricio F Coelho, Wanderley M Bernardo, Sérgio S Junior, Jaime A P Kruger, Gilton M Fonseca, Vagner B Jeismann, Ivan Cecconello, Paulo Herman
BACKGROUND: Preoperative strategies to increase the future liver remnant are useful methods to improve resectability rates for patients with hepatocellular carcinoma (HCC). The aim of this study was to perform a systematic review and meta-analysis of the main strategies used for this purpose. METHODS: A systematic review was performed in PubMed, EMBASE, Cochrane and Scielo/LILACS. The procedures included for analysis were portal vein embolization or ligation (PVE/PVL), sequential transarterial embolization and PVE (TACE + PVE), radioembolization (RE) and associated liver partition and portal vein ligation for staged hepatectomy (ALPPS)...
December 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Jagadeesh Krishnamurthy, Adithya V Naragund, Basant Mahadevappa
Twenty five percent of total liver volume (TLV) is considered as the ideal functional liver remnant (FLR) in major liver resections. In patients with macro-vesicular steatosis, early cirrhosis, and post-neoadjuvant chemotherapy (NACT), hepatocellular injury is common. In such instances, up to 40% of FLR may be required. So in cases of marginal FLR, pre-operative portal vein (PV) embolization or two-stage hepatectomy with PV occlusion is used. Both of which take up to 14 weeks between stages and 30% of patients fail to reach the second resection either due to inadequate FLR growth or disease progression...
June 2018: Indian Journal of Surgery
Naokazu Chiba, Kei Yokozuka, Shigeto Ochiai, Takahiro Gunji, Masaaki Okihara, Toru Sano, Koichi Tomita, Rina Tsutsui, Shigeyuki Kawachi
Background: The aim was to analyze hepatic hypertrophy after portal vein embolization (PVE) and Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) to determine whether clinical circumstances associated with major hepatic resections correlated with remnant growth. Methods: Data was abstracted from a retrospectively maintained database on 27 patients undergoing hepatic resection followed by PVE and the ALPPS procedure between October 1, 2007 and December 31, 2016...
2018: Patient Safety in Surgery
Andreas A Schnitzbauer, Erik Schadde, Michael Linecker, Marcel A Machado, Rene Adam, Massimo Malago, Pierre A Clavien, Eduardo de Santibanes, Wolf O Bechstein
OBJECTIVES: In the international associating liver partition and portal vein ligation for staged hepatectomy registry, more than 50% of patients underwent associating liver partition and portal vein ligation for staged hepatectomy with a right hepatectomy. This study evaluated the necessity of two-stage hepatectomies being performed as right hepatectomy associating liver partition and portal vein ligation for staged hepatectomy in patients with colorectal liver metastases versus right trisectionectomy associating liver partition and portal vein ligation for staged hepatectomy...
September 2018: Surgery
Fiammetta Soggiu, Francesco Giovinazzo, Jack Straiton, Giulia Turri, Jim Phillips, Bassam Al-Kari, Irfan Ahmed, Mohammad Habib
Monosegment 4±1 Associating Liver Partition and Portal Vein ligation for Staged hepatectomy (ALPPS) for bilateral colorectal liver metastases decreases the risk of drop-out of two stage hepatectomy, triggering a rapid and significant increase in future liver remnant (FLR) with promising oncological outcomes. We report two cases of segment 4+1 monosegment ALPPS for multiple colorectal liver metastases performed at our institution. In the literature, seven similar cases have been reported. Short and long term outcomes of our two patients were reported along with a review of data from the literature...
April 2018: Hepatobiliary Surgery and Nutrition
Xiujun Cai
Dramatic progresses had been made in the operation in the past 26 years. Procedure was extended to major liver resection, isolated resection of caudate lobe, living donor liver resection and associating liver partition with portal vein ligation for staged hepatectomy (ALPPS). Laparoscopic liver resection became a new group of HPB surgery and the international laparoscopic liver society was established in Paris followed by the first international congress of the society held in Paris in July 2017. This biannual congress would be top convention for surgeons specialized in laparoscopic liver surgery...
April 2018: Hepatobiliary Surgery and Nutrition
Bruno C Odisio, Eve Simoneau, Alex A Holmes, Claudius H Conrad, Jean-Nicolas Vauthey
No abstract text is available yet for this article.
August 2018: Journal of the American College of Surgeons
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