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ALPPS procedure

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)...
July 26, 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
Hauke Lang, Eduardo de Santibañes, Hans J Schlitt, Massimo Malagó, Thomas van Gulik, Marcel A Machado, Elio Jovine, Stefan Heinrich, Giuseppe Maria Ettorre, Albert Chan, Roberto Hernandez-Alejandro, Ricardo Robles Campos, Per Sandström, Michael Linecker, Pierre-Alain Clavien
OBJECTIVE: Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has been tested in various indications and clinical scenarios, leading to steady improvements in safety. This report presents the current status of ALPPS. SUMMARY BACKGROUND DATA: ALPPS offers improved resectability, but drawbacks are regularly pointed out regarding safety and oncologic benefits. METHODS: During the 12th biennial congress of the European African-Hepato-Pancreato-Biliary Association (Mainz, Germany, May 23-26, 2017) an expert meeting "10th anniversary of ALPP" was held to discuss indications, management, mechanisms of regeneration, as well as pitfalls of this novel technique...
May 1, 2018: Annals of Surgery
Ernesto Sparrelid, Helene Johansson, Stefan Gilg, Greg Nowak, Ewa Ellis, Bengt Isaksson
BACKGROUND: There is limited knowledge about the mechanisms behind the unparalleled growth of the future liver remnant (FLR) linked to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). In this study, liver regenerative markers were examined in patients subjected to ALPPS. METHODS: Ten patients with colorectal liver metastases treated with neoadjuvant chemotherapy and ALPPS were included. Plasma was sampled at 6 time points and biopsies from both liver lobes were collected at both stages of ALPPS...
2018: European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes
Pim B Olthof, Fadi Rassam, Thomas M van Gulik
INTRODUCTION: ALPPS (Associating Liver Partition and Portal vein Ligation for Staged hepatectomy) is a new two-stage hepatectomy for patients in whom conventional treatment is not feasible due to insufficient future liver remnant (FLR). During stage one of ALPPS, accelerated growth of the FLR is induced by ligation of the portal vein and in situ split of the liver, which prevents interlobar collateral portal circulation and attributes to the accelerated hypertrophy response. This can present a risk for postoperative haemorrhage...
2018: International Journal of Surgery Case Reports
Martin Bartas, Jiri Červeň, Jan Oppelt, Matus Peteja, Petr Vávra, Pavel Zonča, Vaclav Procházka, Vaclav Brázda, Petr Pečinka
This present study investigated the impact of the application of stem cells to liver regeneration following the first stage of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). The experiment was conducted on a pig model (n=6, 3 that did not receive application of stem cells, 3 that received application stem cells). Collected samples of liver (day 0 and 9 following surgery) were subjected to complete transcriptome sequencing. In total, 39 differentially expressed genes were found in the group without the application of the stem cells (genes of unwanted processes such as fibrosis and inflammation)...
May 2018: Oncology Letters
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