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https://www.readbyqxmd.com/read/28493147/modified-alpps-procedures-more-safety-through-less-invasive-surgery
#1
REVIEW
Kuniya Tanaka
PURPOSE: Although associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been advocated for treating advanced liver tumors, increased morbidity and mortality remain serious problems. Many modified procedures have been devised to improve patient safety, but some confusion persists as to benefits and risks. METHODS: Modifications to ALPPS as originally reported were reviewed to clarify their contributions to safety and their clinical relevance...
May 10, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28481004/tips-and-pitfalls-in-direct-ligation-of-large-spontaneous-splenorenal-shunt-during-liver-transplantation
#2
Hyeyoung Kim, Kyung Chul Yoon, Kwang-Woong Lee, Nam-Joon Yi, Hae Won Lee, YoungRok Choi, Dongkyu Oh, Hyo-Sin Kim, Suk Kyun Hong, Sung Woo Ahn, Kyung-Suk Suh
Patients with large spontaneous splenorenal shunt (SRS) prove challenging during liver transplantation (LT), irrespective of organizing portal vein (PV) thrombosis. Here, we detail the clinical outcomes of 26 patients who underwent direct ligation of large SRS during LT. Direct ligation of large SRS was applied in poor portal flow during LT. We performed temporary test clamping of the SRS before direct ligation and applied PV pressure monitoring in patients who showed signs of portal hypertension, such as bowel edema...
May 8, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28451728/-laparoscopic-liver-resection
#3
M R Schön, C Justinger
Laparoscopic liver surgery has become an established procedure in the treatment of liver tumors. Due to its short-term and long-term advantages, the number of centers with experience in laparoscopic liver surgery has greatly increased in the last few years. The complexity of the interventions performed has nearly reached the level of open surgery. This article describes the importance of laparoscopic hepatic surgery and discusses the evidence for the procedure. In addition, the indications for the most frequently resected tumors, metastases of colorectal cancer and hepatocellular carcinoma are explained together with important aspects of certain tumor localizations...
April 27, 2017: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
https://www.readbyqxmd.com/read/28447055/associating-liver-partition-and-portal-vein-ligation-for-bleeding-hepatocellular-carcinoma-in-hbv-cirrhosis-a-safety-strategy
#4
Giovanni Battista Levi Sandri, Giovanni Vennarecci, Pasquale Lepiane, Giuseppe Maria Ettorre
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...
2017: Translational Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28445299/endoscopic-ultrasonography-predicts-early-esophageal-variceal-bleeding-in-liver-cirrhosis-a-case-report
#5
Changjun Men, Guoliang Zhang
RATIONALE: Bleeding esophageal and gastric varices constitute a serious complication in liver cirrhosis. Previous studies have shown that endoscopic ultrasonography (EUS) can be used to predict early esophageal variceal bleeding in liver cirrhosis. PATIENT CONCERNS: We report a case of a 46-year-old man with hepatitis B liver cirrhosis (CTP score, 5; Child-Pugh class, A) who was admitted to our hospital due to a decreased appetite lasting 1 week. DIAGNOSIS: He was initially diagnosed with decompensated hepatitis B cirrhosis; an abdominal computed tomography (CT) scan indicated a diagnosis of liver cirrhosis and portal hypertension (PHT)...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28419692/associating-liver-partition-and-portal-vein-ligation-for-staged-hepatectomy-after-pre-operative-chemotherapy
#6
Florian W R Vondran, Felix Oldhafer, Kristina I Ringe, Thomas C Wirth, Moritz Kleine, Mark D Jäger, Juergen Klempnauer, Hueseyin Bektas
BACKGROUND: Recently a procedure termed 'Associating Liver Partition and Portal vein ligation for Staged hepatectomy' (ALPPS) was developed to increase the resectability of marginally resectable or locally unresectable liver tumours. This study focused on the application of ALPPS in patients with advanced colorectal liver metastases (CRLM) and pre-operative chemotherapy, with the aim to investigate whether the latter still allows for sufficient hypertrophy of the future liver remnant (FLR) following the first step of ALPPS...
April 16, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28410744/rapid-liver-volume-increase-induced-by-associating-liver-partition-with-portal-vein-ligation-for-staged-hepatectomy-alpps-is-it-edema-steatosis-or-true-proliferation
#7
Dilmurodjon Eshmuminov, Christoph Tschuor, Dimitri Aristotle Raptis, Andreas Boss, Moritz C Wurnig, Gregory Sergeant, Erik Schadde, Pierre-Alain Clavien
No abstract text is available yet for this article.
April 12, 2017: Surgery
https://www.readbyqxmd.com/read/28408101/a-new-technique-for-accelerated-liver-regeneration-an-experimental-study-in-rats
#8
Kasper Jarlhelt Andersen, Anders Riegels Knudsen, Betina Norman Jepsen, Michelle Meier, Anders Patrik Alexander Gunnarsson, Uffe Birk Jensen, Jens Randel Nyengaard, Stephen Hamilton-Dutoit, Frank Viborg Mortensen
BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is used to accelerate growth of the future liver remnant. We investigated alternative methods for increasing the future liver remnant. METHODS: A total of 152 rats were randomized as follows: (1) sham; (2) portal vein ligation; (3) portal vein ligation/surgical split (ALPPS); (4) portal vein ligation/split of the liver with a radiofrequency ablation needle; (5) portal vein ligation/radiofrequency ablation of the deportalized liver (portal vein ligation/radiofrequency ablation necrosis in the deportalized liver); (6) portal vein ligation/radiofrequency ablation of the future liver remnant (portal vein ligation/radiofrequency ablation-future liver remnant); and (7) controls...
April 10, 2017: Surgery
https://www.readbyqxmd.com/read/28398026/associating-liver-partition-and-portal-vein-ligation-for-staged-hepatectomy-versus-conventional-staged-hepatectomy-a-meta-analysis
#9
Yin Zhang, Yidi Zheng, Xuesong Dong, Xuepu Sun, Xian Jiang, Zhuozhong Wang, Haiquan Qiao
INTRODUCTION: Controversies persist between associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and conventional staged hepatectomy. This meta-analysis aims to compare completion, regeneration capacity, and surgical outcomes between the two strategies. EVIDENCE ACQUISITION: We systematically searched PubMed, Embase, Cochrane Library, Medline. The main endpoints consisted of completion rate, future liver remnant (FLR) hypertrophy ratio, morbidity, major complication, minor complication, posthepatectomy liver failure (PHLF) and mortality...
April 11, 2017: Minerva Medica
https://www.readbyqxmd.com/read/28395956/benefit-of-an-implanted-solid-barrier-for-the-feasibility-of-a-sequence-of-three-different-hepato-biliary-operations-in-a-small-animal-model
#10
B Richter, C Sänger, F Mussbach, H Scheuerlein, U Settmacher, U Dahmen
BACKGROUND: Current liver surgery includes complex multi-stage procedures such as portal vein ligation (PVL) followed by extended liver resection, especially in patients with Klatskin tumours. The risk for severe adhesions increases with every procedure. Finally, this complex sequence could fail because of malignant adhesions. Therefore, we proved the hypothesis of reducing malignant adhesions and increasing feasibility of a sequence with three hepato-biliary operations by implantation of a solid barrier...
April 8, 2017: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/28381377/current-technical-aspects-of-oncological-hepatic-surgery
#11
Ahmed I Salem, Emily R Winslow
BACKGROUND: With the recent advances in oncological hepatic surgery, major liver resections became more widely utilized procedures. The era of modern hepatic surgery witnessed improvements in patients care in preoperative, intraoperative and postoperative aspects. This significantly improved surgical outcomes regarding morbidity and mortality. This review article focuses on the recent advances in oncological hepatic surgery. DATA SOURCES: This review includes only data from peer-reviewed articles and journals...
April 2017: Hepatobiliary & Pancreatic Diseases International: HBPD INT
https://www.readbyqxmd.com/read/28365007/future-remnant-liver-function-as-predictive-factor-for-the-hypertrophy-response-after-portal-vein-embolization
#12
Kasia P Cieslak, Floor Huisman, Thomas Bais, Roelof J Bennink, Krijn P van Lienden, Joanne Verheij, Marc G Besselink, Olivier R C Busch, Thomas M van Gulik
BACKGROUND: Preoperative portal vein embolization is widely used to increase the future remnant liver. Identification of nonresponders to portal vein embolization is essential because these patients may benefit from associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), which induces a more powerful hypertrophy response. (99m)Tc-mebrofenin hepatobiliary scintigraphy is a quantitative method for assessment of future remnant liver function with a calculated cutoff value for the prediction of postoperative liver failure...
March 29, 2017: Surgery
https://www.readbyqxmd.com/read/28344745/can-molecular-biomarkers-replace-a-clinical-risk-score-for-resectable-colorectal-liver-metastasis
#13
EDITORIAL
Torhild Veen, Kjetil Søreide
In resectable colorectal liver metastasis (CRLM) the role and use of molecular biomarkers is still controversial. Several biomarkers have been linked to clinical outcomes in CRLM, but none have so far become routine for clinical decision making. For several reasons, the clinical risk score appears to no longer hold the same predictive value. Some of the reasons include the ever expanding indications for liver resection, which now increasingly tend to involve extrahepatic disease, such as lung metastases (both resectable and non-resectable) and the shift in indication from "what is taken out" (e...
March 15, 2017: World Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/28288067/modified-associating-liver-partition-and-portal-vein-ligation-for-staged-hepatectomy-for-hepatoblastoma-in-a-small-infant-how-far-can-we-push-the-envelope
#14
Johnny C Hong, Joohyun Kim, Meghen Browning, Amy Wagner, Stacee Lerret, Annette D Segura, Michael A Zimmerman
For patients with hepatoblastoma, a timely and complete resection of the tumor is critical to the patient's tumor recurrence-free survival. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), a 2-stage hepatectomy procedure, has revolutionized the surgical management of large hepatic tumors with insufficient future liver remnant (FLR) at presentation. Although existing data support the utility of ALPPS in adults with primary and metastatic hepatobiliary malignancy, the literature in children is scarce...
March 10, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28283924/dynamic-evaluation-of-liver-volume-and-function-in-associating-liver-partition-and-portal-vein-ligation-for-staged-hepatectomy
#15
Ernesto Sparrelid, Eduard Jonas, Antonios Tzortzakakis, Ulrika Dahlén, Gustav Murquist, Torkel Brismar, Rimma Axelsson, Bengt Isaksson
BACKGROUND: Despite a fast and potent growth of the future liver remnant (FLR), patients operated with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are at risk of developing posthepatectomy liver failure. In this study, the relation between liver volume and function in ALPPS was studied using a multimodal assessment. METHODS: Nine patients with colorectal liver metastases treated with neoadjuvant chemotherapy and operated with ALPPS were studied with hepatobiliary scintigraphy, computed tomography, indocyanine green clearance test, and serum liver function tests...
March 10, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28282272/role-of-serum-soluble-cd163-in-the-diagnosis-risk-of-bleeding-and-prognosis-of-gastro-esophageal-varices-in-cirrhotic-patients
#16
Rabab Fouad, Iman Hamza, Marwa Khairy, Marwa Elsharkawy, Amal A Helmy
Research is continuous for noninvasive tools for the prediction of portal hypertension than upper gastrointestinal endoscopy. Serum sCD163 correlates with hepatic venous pressure gradient, aiding in the prediction of portal hypertension. We aimed at investigating the role of sCD163 in the prediction of the presence and size of varices as well as a stratification tool for surveillance or prophylaxis by assessment of prognosis and risk of bleeding. Two hundred forty-three cirrhotic patients were divided into 3 groups: group I: no varices, group II: small-sized varices, and group III: medium-sized and large-sized varices...
March 2017: Journal of Interferon & Cytokine Research
https://www.readbyqxmd.com/read/28279621/high-mortality-after-alpps-for-perihilar-cholangiocarcinoma-case-control-analysis-including-the-first-series-from-the-international-alpps-registry
#17
Pim B Olthof, Robert J S Coelen, Jimme K Wiggers, Bas Groot Koerkamp, Massimo Malago, Roberto Hernandez-Alejandro, Stefan A Topp, Marco Vivarelli, Luca A Aldrighetti, Ricardo Robles Campos, Karl J Oldhafer, William R Jarnagin, Thomas M van Gulik
INTRODUCTION: Resection of perihilar cholangiocarcinoma (PHC) entails high-risk surgery with postoperative mortality reported up to 18%, even in specialized centers. The aim of this study was to compare outcomes of PHC patients who underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to patients who underwent resection without ALPPS. METHODS: All patients who underwent ALPPS for PHC were identified from the international ALPPS registry and matched controls were selected from a standard resection cohort from two centers based on future remnant liver size...
March 6, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/28273656/animal-models-for-associating-liver-partition-and-portal-vein-ligation-for-staged-hepatectomy-alpps-achievements-and-future-perspectives
#18
Andras Budai, Andras Fulop, Oszkar Hahn, Peter Onody, Tibor Kovacs, Tibor Nemeth, Miklos Dunay, Attila Szijarto
BACKGROUND: Since 2012, Associated Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has been standing in the limelight of modern liver surgery and numerous questions have been raised regarding this novel approach. On the one hand, ALPPS has proved to be a valuable method in the treatment of hepatic tumors, while on the other hand, there are many controversies, such as high mortality and morbidity rates. Further surgical research is essential for a better understanding of underlying mechanisms and for enhancing patient safety...
2017: European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes
https://www.readbyqxmd.com/read/28270160/alpps-associating-liver-partition-and-portal-vein-ligation-for-staged-hepatectomy-does-not-affect-proliferation-apoptosis-or-angiogenesis-as-compared-to-standard-liver-resection-for-colorectal-liver-metastases
#19
Katharina Joechle, Christian Moser, Petra Ruemmele, Katharina M Schmidt, Jens M Werner, Edward K Geissler, Hans J Schlitt, Sven A Lang
BACKGROUND: ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a novel two-stage strategy to induce rapid hypertrophy of the future liver remnant (FLR) when patients are in danger of postoperative liver failure due to insufficient FLR. However, the effects of ALPPS on colorectal liver metastases (CRLM) are not clear so far. The aim of our study was to determine whether ALPPS induces proliferation, apoptosis, or vascularization compared to standard (one-stage) liver resection...
March 7, 2017: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28267203/expanding-the-limits-of-resectability-associating-liver-partition-and-portal-vein-ligation-for-staged-hepatectomy-alpps-using-monosegment-6-facilitated-by-an-inferior-right-hepatic-vein
#20
Karen Pineda-Solís, Dave Paskar, Mauro Tun-Abraham, Roberto Hernandez-Alejandro
We describe our technique using the combination of a recent surgical technique (ALPPS) and an anomalous vascular anatomy to push the current limits of liver resectability. The approach allowed the resection of the three hepatic veins and preserved a peripheral segment 6 as the only future liver remnant, having an inferior hepatic vein as its outflow.
March 7, 2017: Journal of Surgical Oncology
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