A case presentation of ALPPS procedure for liver resection
Abstract
In patient with colorectal liver metastases only surgery is associated with a survival plateau. Main factors for resection are localizations of metastasis and functional liver remnant. To prevent liver failure after extended hepatic resection we perform two stage procedure with portal vein ligation or embolisation. In March 2012 was published first large study for new technique of two stage hepatic resection. In fisrt procedure surgeon performed in situ resection with perservation of arteries, vein and bile ducts. After one week CT was performed and if adequate hypertrophy of liver remain was observed final procedure with removal of transected liver was performed. Authors describe 100% hypertrophy of future liver remant in 1 to 2 week period. We will describe first procedure performed in Slovenia in our clinical department.
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References
Rak v Sloveniji 2012. Ljubljana: Onkološki inštitut Ljubljana, Epidemiologija in register raka, Register raka Republike Slovenije; 2012.
Shimada H, Tanaka K, Endou I, Ichikawa Y. Treatment for colorectal liver metastases: a review. Langenbecks Arch Surg. 2009; 394 (6): 973–983.
Abbas S, Lam V, Hollands M. Ten-year survival afer liver resection for colorectal metastases: systematic review and metaanalysis. ISRN Oncol. 2011; 2011: 763245.
Ivanecz A, Potrč S, Horvat M, Gadžijev E. Zdravljenje bolnikov z jetrnimi zasevki raka debelega črevesa in danke na oddelku za abdominalno kirurgijo Splošne bolnišnice Maribor. Zdrav Vestn. 2007; 76 (4): 237–43.
Shindoh J, Vauthey JN, Zimmitti G, Curley SA, Huang SY, Mahvash A, et al. Analysis of the efcacy of portal vein embolization for patients with extensive liver malignancy and very low future liver remnant volume, including a comparison with the associating liver partition with portal vein ligation for staged hepatectomy approach. J Am Coll Surg. 2013; 217 (1): 126–133; discussion 133–134.
Hasselgren K, Sandström P, Björnsson B. Role of associating liver partition and portal vein ligation for staged hepatectomy in colorectal liver metastases: a review. World J Gastroenterol. 2015; 21 (15): 4491–4498.
Alvarez FA, Ardiles V, Sanchez Claria R, Pekolj J, de Santibanes E. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks. J Gastrointest Surg. 2013; 17 (4): 814–821.
Schnitzbauer AA, Lang SA, Goessmann H, Nadalin S, Baumgart J, Farkas SA, et al. Right portal vein ligation combined with in situ splitting induces rapid lef lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012; 255 (3): 405–414.
Cavaness KM,Majella Doyle MB , Linn Y, Maynard E, Chapman WC. Using ALPPS to Induce Rapid Liver Hypertrophy in a Patient with Hepatic Fibrosis and Portal Vein Trombosis. J Gastrointest Surg. 2013; 17 (1): 201–212.
Govil S. Rapid improvement in liver volume induced by portal vein ligation and staged hepatectomy: the ALPPS procedure. HPB (Oxford). 2012; 14 (12): 874.
Hoekstra LT, van Lienden KP, Doets A, Busch OR, Gouma DJ, van Gulik TM. Tumor progression afer preoperative portal vein embolization. Ann Surg. 2012; 256 (5): 812–817.
Kokudo N, Tada K, Seki M, Ohta H, Azekura K, Ueno M. Proliferative activity of intrahepatic colorectal metastases afer preoperative hemihepatic portal vein embolization. Hepatology. 2001; 34 (2): 267–272.
Schadde E, Ardiles V, Slankamenac K, Tschuor C, Sergeant G, Amacker N, Baumgart J, Croome K, Hernandez-Alejandro R, Lang H, de Santibaňes E, Clavien PA. ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis. World J Surg. 2014; 38 (6): 1510–1519.
Schadde E, Schnitzbauer AA, Tschuor C, Raptis DA, Bechstein WO, Clavien PA. Systematic Review and Meta-Analysis of Feasibility, Safety, and Efcacy of a Novel Procedure: Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy. Ann Surg Oncol. 2015 ; 22 (9): 3109–20.
Sala S, Ardiles V, Ulla M, Alvarez F, Pekolj J, de Santibanes E. Our initial experience with ALPPS technique: encouraging results. Updates Surg. 2012; 64 (3): 167–172.
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 (3): e9.
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