Hauke Lang1, Eduardo de Santibañes2, Hans J Schlitt3, Massimo Malagó4, Thomas van Gulik5, Marcel A Machado6, Elio Jovine7, Stefan Heinrich1, Giuseppe Maria Ettorre8, Albert Chan9, Roberto Hernandez-Alejandro10, Ricardo Robles Campos11, Per Sandström12, Michael Linecker13, Pierre-Alain Clavien13. 1. Department of General, Visceral and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany. 2. Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina. 3. Department of Surgery, University of Regensburg, Regensburg, Germany. 4. Department of HPB- and Liver Transplantation Surgery, University College London, Royal Free Hospitals, London, UK. 5. Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 6. Department of Surgery, University of São Paulo, São Paulo, Brazil. 7. Department of Surgery, Maggiore Hospital, Bologna, Italy. 8. Department of Surgery, Camillo Hospital, Rome, Lazio, Italy. 9. Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong. 10. Division of Transplantation, Hepatobiliary Surgery, University of Rochester, Rochester, NY. 11. Department of Surgery and Liver and Pancreas Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain. 12. Department of Surgery and Clinical and Experimental Medicine, University of Linkoping, Linkoping, Sweden. 13. Swiss HPB and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
Abstract
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. The aim of the meeting was to make an inventory of what has been achieved and what remains unclear in ALPPS. RESULTS: Precise knowledge of liver anatomy and its variations is paramount for success in ALPPS. Technical modifications, mainly less invasive approaches like partial, mini- or laparoscopic ALPPS, mostly aiming at minimizing the extensiveness of the first-stage procedure, are associated with improved safety. In fibrotic/cirrhotic livers the degree of future liver remnant hypertrophy after ALPPS appears some less than that in noncirrhotic. Recent data from the only prospective randomized controlled trial confirmed significant higher resection rates in ALPPS with similar peri-operative morbidity and mortality rates compared with conventional 2-stage hepatectomy including portal vein embolization. ALPPS is effective reliably even after failure of portal vein embolization. CONCLUSIONS: Although ALPPS is now an established 2-stage hepatectomy additional data are warranted to further refine indication and technical aspects. Long-term oncological outcome results are needed to establish the place of ALPPS in patients with initially nonresectable liver tumors.
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. The aim of the meeting was to make an inventory of what has been achieved and what remains unclear in ALPPS. RESULTS: Precise knowledge of liver anatomy and its variations is paramount for success in ALPPS. Technical modifications, mainly less invasive approaches like partial, mini- or laparoscopic ALPPS, mostly aiming at minimizing the extensiveness of the first-stage procedure, are associated with improved safety. In fibrotic/cirrhotic livers the degree of future liver remnant hypertrophy after ALPPS appears some less than that in noncirrhotic. Recent data from the only prospective randomized controlled trial confirmed significant higher resection rates in ALPPS with similar peri-operative morbidity and mortality rates compared with conventional 2-stage hepatectomy including portal vein embolization. ALPPS is effective reliably even after failure of portal vein embolization. CONCLUSIONS: Although ALPPS is now an established 2-stage hepatectomy additional data are warranted to further refine indication and technical aspects. Long-term oncological outcome results are needed to establish the place of ALPPS in patients with initially nonresectable liver tumors.
Authors: Henrik Petrowsky; Ralph Fritsch; Matthias Guckenberger; Michelle L De Oliveira; Philipp Dutkowski; Pierre-Alain Clavien Journal: Nat Rev Gastroenterol Hepatol Date: 2020-07-17 Impact factor: 46.802
Authors: Jan Bednarsch; Zoltan Czigany; Isabella Lurje; Pavel Strnad; Philipp Bruners; Tom Florian Ulmer; Marcel den Dulk; Georg Lurje; Ulf Peter Neumann Journal: Langenbecks Arch Surg Date: 2019-11-16 Impact factor: 3.445
Authors: F Dondorf; A Ali Deeb; A Bauschke; P Felgendreff; H M Tautenhahn; M Ardelt; U Settmacher; F Rauchfuss Journal: Langenbecks Arch Surg Date: 2021-05-10 Impact factor: 3.445