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Role of associating liver partition and portal vein ligation for staged hepatectomy in colorectal liver metastases:A review

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World Journal of Gastroenterology 2015年第15期21卷 4491-4498页

作者： Kristina Hasselgren Per Sandstrom bergthor bjornsson Department of Surgery County Council of Ostergotland Linkoping University 58185 Linkoping Sweden Department of Clinical and Experimental Medicine Faculty of Health Sciences Linkoping University 58185 Linkoping Sweden

Colorectal cancer is the third most common cancer in the Western world. Approximately half of patients will develop liver metastases, which is the most common cause of death. The only potentially curative treatment is surgical resection. However, many patients retain a to small future liver remnant(FLR) to allow for resection directly. There are therefore strategies todecrease the tumor with neoadjuvant chemotherapy and to increase the FLR. An accepted strategy to increase the FLR is portal vein occlusion(PVO). A concern with this strategy is that a large proportion of patients will never be operated because of progression during the interval between PVO and resection. ALPPS(associating liver partition and portal vein ligation for staged hepatectomy) is a new procedure with a high resection rate. A concern with this approach is the rather high frequency of complications and high mortality, compared to PVO. In this review, it is shown that with ALPPS the resection rate was 97.1% for CRLM and the mortality rate for all diagnoses was 9.6%. The mortality rate was likely lower for patients with CRLM, but some data were lacking in the reports. Due to the novelty of ALPPS, the indications and technique are not yet established but there are arguments for ALPPS in the context of CRLM and a small FLR.

关键词： Colorectal liver metastases Associating liver partition and portal vein ligation for staged hepatectomy Portal vein embolization Neoadjuvant chemotherapy Liver surgery

Conventional, but not remote ischemic preconditioning, reduces iNOS transcription in liver ischemia/reperfusion

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World Journal of Gastroenterology 2014年第28期20卷 9506-9512页

作者： bergthor bjornsson Anders Winbladh Linda Bojmar Tommy Sundqvist Per Gullstrand Per Sandstrom Department of Surgery County Council of Ostergotland58185 Linkoping Sweden Department of Clinical and Experimental Medicine Faculty of Health SciencesLinkping University58185 Linkoping Sweden

AIM:To study the effects of preconditioning on inducible nitric oxide synthase(iNOS)and interleukin 1(IL-1)receptor transcription in rat liver ischemia/reperfusion injury(IRI).METHODS:Seventy-two male rats were randomized into 3 groups:the one-hour segmental ischemia(IRI,n=24)group,the ischemic preconditioning(IPC,n=24)group or the remote ischemic preconditioning(RIPC,n=24)*** IPC and R-IPC were performed as 10 min of ischemia and 10 min of *** iNOS and the IL-1 receptor mRNA in the liver tissue was analyzed with real time *** total Nitrite and Nitrate(NOx)in continuously sampled microdialysate(MD)from the liver was *** addition,the NOx levels in the serum were ***:After 4 h of reperfusion,the iNOS mRNA was significantly higher in the R-IPC(ΔCt:3.44±0.57)group than in the IPC(ΔCt:5.86±0.82)group(P=0.025).The IL-1 receptor transcription activity was reduced in the IPC group(ΔCt:1.88±0.53 to 4.81±0.21),but not in the R-IPC group,during reperfusion(P=0.027).In the MD,a significant drop in the NOx levels was noted in the R-IPC group(12.3±2.2 to 4.7±1.2μmol/L)at the end of ischemia compared with the levels in early ischemia(P=0.008).A similar trend was observed in the IPC group(11.8±2.1 to 6.4±1.5μmol/L),although this difference was not statistically *** levels of NOx rose quickly during reperfusion in both ***:IPC,but not R-IPC,reduces iNOS and IL-1 receptor transcription during early reperfusion,indicating a lower inflammatory *** is consumed in the ischemic liver lobe.

关键词： Ischemia-reperfusion injury Preconditioning Remote preconditioning Liver ischemia Liver surgery Microdialysis Nitric oxide Inducible nitric oxide synthase Interleukin-1 receptor

Development and internal validation of the Comprehensive ALPPS Preoperative Risk Assessment(CAPRA)score:is the patient suitable for Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)?

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Hepatobiliary Surgery and Nutrition 2022年第1期11卷 52-66,I0007,I0008页

作者： Ivan Capobianco Karl J.Oldhafer Mohammed-Hossein Fard-Aghaie Ricardo Robles-Campos Roberto Brusadin Henrik Petrowsky Michael Linecker Arianeb Mehrabi Katrin Hoffmann Jun Li Asmus Heumann Roberto Hernandez-Alejandro Mauro Enrique Tun-Abraham Elio Jovine Matteo Serenari bergthor bjornsson Per Sandström Ruslan Alikhanov Mikhail Efanov Paolo Muiesan Andrea Schlegel Thomas M.van Gulik Pim B.Olthof Gregor Alexander Stavrou Lina Maria Serna-Higuita Alfred Königsrainer Silvio Nadalin Department of General Visceral and Transplant SurgeryUniversity Hospital TübingenTübingenGermany Department of General and Abdominal Surgery Asklepios Hospital BarmbekHamburgGermany Department of Surgery Virgen de la Arrixaca Clinic and University HospitalMurciaSpain Swiss HPB and Transplantation Center Department of SurgeryZurich University HospitalZurichSwitzerland Department of General Visceraland Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany General Visceral and Thoracic Surgery Department and ClinicHamburg-Eppendorf University Medical CenterHamburgGermany Division of Transplantation and Hepatobiliary Surgery University of RochesterRochesterNYUSA Division of HPB Surgery and Liver Transplantation Department of SurgeryLondon Health Sciences CentreLondonCanada General and Emergency Surgery Unit Azienda Ospedaliero-Universitaria di BolognaMaggiore HospitalBolognaItaly General Surgery and Transplantation Unit Azienda Ospedaliero-Universitaria di BolognaSant’Orsola-Malpighi HospitalBolognaItaly Department of Surgery in Linköping and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden Department of Hepatopancreatobiliary Surgery Moscow Clinical Scientific CenterMoscowRussia Liver Unit Queen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK Department of Surgery Amsterdam UMC(Location AMC)University of AmsterdamAmsterdamThe Netherlands Department of General Abdominal and Thoracic SurgerySurgical OncologySaarbruecken General HospitalSaarbrueckenGermany Department of Clinical Epidemiology and Applied Biometry University of TübingenTübingenGermany

Background:Preoperative patient selection in Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)is not always reliable with currently available scores,particularly in patients with primary liver *** study aims to(I)to determine whether comorbidities and patients characteristics are a risk factor in ALPPS and(II)to create a score predicting 90-day mortality ***:Thirteen high-volume centers participated in this retrospective multicentric study.A risk analysis based on patient characteristics,underlying disease and procedure type was performed to identify risk factors and model the Comprehensive ALPPS Preoperative Risk Assessment(CAPRA)score.A nonparametric receiver operating characteristic analysis was performed to estimate the predictive ability of our score against the Charlson Comorbidity Index(CCI),the age-adjusted CCI(aCCI),the ALPPS risk score before Stage 1(ALPPS-RS1)and Stage 2(ALPPS-RS2).The model was internally validated applying ***:A total of 451 patients were *** was 14.4%.The CAPRA score is calculated based on the following formula:(0.1×age)−(2×BSA)+1(in the presence of primary liver tumor)+1(in the presence of severe cardiovascular disease)+2(in the presence of moderate or severe diabetes)+2(in the presence of renal disease)+2(if classic ALPPS is planned).The predictive ability was 0.837 for the CAPRA score,0.443 for CCI,0.519 for aCCI,0.693 for ALPPS-RS1 and 0.807 for *** 1,000 cycles of bootstrapping the C statistic was *** accuracy plot revealed a cut-off for optimal prediction of postoperative mortality of ***:Comorbidities play an important role in ALPPS and should be carefully considered when planning the *** assessing the patient’s preoperative condition in relation to ALPPS,the CAPRA score has a very good ability to predict postoperative mortality.

关键词： Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS) comorbidity mortality prediction model patient selection

Laparoscopic distal pancreatectomy for adenocarcinoma of the pancreas

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World Journal of Gastroenterology 2014年第37期20卷 13402-13411页

作者： bergthor Bjrnsson Per Sandstrm Department of Surgery County Council of stergtland and Department of Clinical and Experimental MedicineFaculty of Health SciencesLinkping University

Since the first report on laparoscopic distal pancreatec tomy(LDP) appeared in the 1990 s, the procedure ha been performed increasingly frequently to treat both benign and malignant lesions of the pancreas. Man earlier publications have shown LDP to be a good alter native to open distal pancreatectomy for benign lesions although this has never been studied in a prospective randomized manner. The evidence for the use of LDP to treat adenocarcinoma of the pancreas is not as we established. The purpose of this review is to evaluat the current evidence for LDP in cases of pancreati adenocarcinoma. We conducted a review of English language publications reporting LDP results between1990 and 2013. All studies reporting results in patient with histologically proven pancreatic adenocarcinom were included. Thirty-nine publications were found and included in the results for a total of 309 cases of pan creatic adenocarcinoma(potential double publication were not eliminated). Most LDP procedures are per formed in selected cases and generally involve smalle tumors than open distal pancreatectomy(ODP) proce dures. Some of the papers report unselected cases andinclude procedures on larger tumors. The number of lymph nodes harvested using LDP is comparable to the number obtained with ODP, as is the frequency of R0 resections. Current data suggest that similar short term oncological results can be obtained using LDP as those obtained using ODP.

关键词： Adenocarcinoma of the pancreas Laparoscopy Distal

Nitrite,a novel method to decrease ischemia/reperfusion injury in the rat liver

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World Journal of Gastroenterology 2015年第6期21卷 1775-1783页

作者： bergthor Bjrnsson Linda Bojmar Hans Olsson Tommy Sundqvist Per Sandstrm Department of Surgery County Council of ?sterg?tland Department of Clinical and Experimental Medicine Faculty of Health Sciences Link?ping University Department of Pathology County Council of ?sterg?tland

AIM:To investigate whether nitrite administered prior to ischemia/reperfusion(I/R)reduces liver ***:Thirty-six male Sprague-Dawley rats were randomized to 3 groups,including sham operated(n=8),45-min segmental ischemia of the left liver lobe(IR,n=14)and ischemia/reperfusion(I/R)preceded by the administration of 480 nmol of nitrite(n=14).Serum transaminases were measured after 4 h of *** microdialysate(MD)was sampled in 30-min intervals and analyzed for glucose,lactate,pyruvate and glycerol as well as the total nitrite and nitrate(NOx).The NOx was measured in ***:Aspartate aminotransferase(AST)at the end of reperfusion was higher in the IR group than in the nitrite group(40±6.8μkat/L vs 22±2.6μkat/L,P=0.022).Similarly,alanine aminotransferase(ALT)was also higher in the I/R group than in the nitrite group(34±6μkat vs 14±1.5μkat,P=0.0045).The NOx in MD was significantly higher in the nitrite group than in the I/R group(10.1±2.9μmol/L vs 3.2±0.9μmol/L,P=0.031)after the administration of *** ischemia,the levels decreased in both groups and then increased again during *** the end of reperfusion,there was a tendency towards a higher NOx in the I/R group than in the nitrite group(11.6±0.7μmol/L vs 9.2±1.1μmol/L,P=0.067).Lactate in MD was significantly higher in the IR group than in the nitrite group(3.37±0.18 mmol/L vs 2.8±0.12 mmol/L,P=0.01)during ischemia and the first 30 min of *** the same period,glycerol was also higher in the IRI group than in the nitrite group(464±38μmol/L vs 367±31μmol/L,P=0.049).With respect to histology,there were more signs of tissue damage in the I/R group than in the nitrite group,and29%of the animals in the I/R group exhibited necrosis compared with none in the nitrite *** nitric oxide synthase transcription increased between early ischemia(t=15)and the end of reperfusion in both ***:Nitrite administered before liver ischemia in the rat liver redu

关键词： Ischemia-reperfusion injury Nitrite Liver ischemia

How should liver hypertrophy be stimulated?A comparison of upfront associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)and portal vein embolization(PVE)with rescue possibility

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Hepatobiliary Surgery and Nutrition 2021年第1期10卷 1-8页

作者： Ernesto Sparrelid Kristina Hasselgren Bård Ingvald Røsok Peter Nørgaard Larsen Nicolai Aagaard Schultz Ulrik Carling Eva Fallentin Stefan Gilg Per Sandström Gert Lindell bergthor Björnsson Department of Clinical Science Intervention and TechnologyDivision of SurgeryKarolinska InstituteKarolinska University HospitalStockholmSweden Department of Surgery and Clinical and Experimental Medicine Linköping UniversityLinköpingSweden Department of Hepato-Pancreato-Biliary Surgery Oslo University HospitalOsloNorway Department of Surgical Gastroenterology and Transplantation RigshospitaletUniversity of CopenhagenDenmark Department of Radiology and Nuclear Medicin RikshospitaletOslo University HospitalOsloNorway Department of Radiology RigshospitaletUniversity of CopenhagenCopenhagenDenmark Department of Surgery Skane University HospitalLundSweden

Background:The role of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)in comparison to portal vein embolization(PVE)is *** aim of this study was to compare successful resection rates(RR)with upfront ALPPS *** with rescue ALPPS on demand and to compare the hypertrophy of the liver between ALPPS and PVE plus subsequent rescue ***:A retrospective analysis of all patients treated with PVE for colorectal liver metastasis(CRLM)or ALPPS(any diagnosis,rescue ALPPS included)at five Scandinavian university hospitals during the years 2013-2016 was conducted.A Chi-square test and a Mann-Whitney U test were used to assess the difference between the groups.A successful RR was defined as liver resection without a 90-day ***:A total of 189 patients were *** RR was in 84.5%of the patients with ALPPS upfront and in 73.3%of the patients with PVE and rescue ALPPS on demand(P=0.080).The hypertrophy of the future liver remnants(FLRs)with ALPPS upfront was 71%(48-97%)compared to 96%(82-113%)after PVE and rescue ALPPS(P=0.010).Conclusions:Upfront ALPPS offers a somewhat higher successful RR than PVE with rescue ALPPS on *** sequential combination of PVE and ALPPS leads to a higher overall degree of hypertrophy than upfront ALPPS.

关键词： Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) liver surgery colorectal liver metastases(CRLM) portal vein embolization(PVE)