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Modifications of ALPPS–from complex to more complex or from complex to less complex operations

Hepatobiliary & Pancreatic Diseases International 2017年第4期16卷 346-352页

作者： Wan Yee Lau Eric CH Lai Faculty of Medicine The Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina Department of Surgery Pamela Youde Nethersole Eastern HospitalHong Kong SARChina

BACKGROUND: associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been developed to induce rapid liver hypertrophy to reduce the chance of post-hepatectomy liver failure in patients with borderline or insufficient future liver remnant. ALPPS is still in an early developmental stage and its techniques have not been standardized. This study aimed to review the technical modifications of the conventional ALPPS procedure. DATA SOURCES: Studies were identified by searching MEDLINE and PubMed for articles published from January 2007 to December 2016 using the keywords 'associating liver partition and portal vein ligation for staged hepatectomy' and 'ALPPS'. Additional articles were identified by a manual search of references from key articles. RESULTS: There have been a lot of modifications of the conventional ALPPS. These are classified as: (1) modifications aiming to improve surgical results; (2) modifications aiming to expand surgical indications; (3) salvage ALPPS; (4) ALPPS using the minimally invasive approach. Some of these modifications have made the conventional ALPPS procedure to become even more complex, although there have also been other attempts to make the procedure less complex. The results of most of these modifications have been reported in small case series or case reports. We need better well-designed studies to establish the true roles of these modifications. However, it is interesting to see how this conventional ALPPS procedure has evolved since its introduction. CONCLUSIONS: There is a trend for the use of minimally invasive procedure in the phase 1 or 2 of the conventional ALPPS procedure. Some of these modifications have expanded the use of ALPPS in patients who have been considered to have unresectable liver tumors. The long-term oncological outcomes of these modifications are still unknown.

关键词： associating liver partition and portal vein ligation for stage hepatectomy hepatocellular carcinoma hepatectomy liver metastasis portal vein embolization

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Little girl who conquered the "ALPPS''

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World Journal of Gastroenterology 2014年第29期20卷 10208-10211页

作者： Albert Chan Patrick HY Chung Ronnie TP Poon Division of Hepatobiliary and Pancreatic Surgery and liver Transplantation Department of SurgeryQueen Mary HospitalThe University of Hong Kong Division of Pediatric Surgery Department of SurgeryQueen Mary Hospitalthe University of Hong Kong

An insufficient future liver remnant(FLR)is associated with post-hepatectomy liver *** liver partition and portal vein ligation for stage hepatectomy(ALPPS)has been shown to be effective for the induction of rapid FLR hypertrophy so as to improve the resectability in patients with insufficient *** hereby report our experience of this novel approach for a 6-year-old patient with *** tomography showed a hepatoblastoma measuring12.5 cm×9.9 cm×11.7 cm in the right liver(Couinaud segmentⅣ,ⅤandⅧ).Volumetric assessment of the FLR i.e.,left lateral section was 112.6 mL i.e.,21.2%of the estimated total liver *** view of the small-for-size FLR,ALPPS was *** anterior approach was adopted for the in-situ parenchymal split without mobilisation of the right *** volumetry on the seventh postoperative day was 160.7 mL,which represented a 46.1%gain in volume,and a FLR/ESLV ratio of 30.2%.A right trisectionectomy was performed on the eighth postoperative *** recovery was *** was discharged on day 16 after the first *** our knowledge,this was the first report that showed the applicability of ALPPS to a paediatric patient.

关键词： associating liver partition and portal vein ligation for stage hepatectomy hepatectomy portal vein Hepatoblastoma In-situ split

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