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Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure
Published on: August 14, 2017
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Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy.
Erik Schadde1, Massimo Malagó2, Roberto Hernandez-Alejandro3
1Department of Surgery, and Institute of Physiology, Kantonsspital Winterthur, and University of Zurich, Zurich, Switzerland.
Surgery
|February 26, 2015
Summary
Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) enables monosegment liver resections. This approach facilitates extensive hypertrophy, allowing for previously unresectable liver metastases to be treated with a single liver segment remnant.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Liver transplantation
Background:
- Major liver resections are typically limited to preserving at least two Couinaud segments due to remnant liver function.
- Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is a technique that induces significant liver hypertrophy, enabling more extensive liver resections.
Purpose of the Study:
- To evaluate the feasibility and outcomes of monosegment liver resections using the ALPPS technique.
- To analyze patient selection, surgical technique, complications, and survival in cases of extreme liver resection with a single segment remnant.
Main Methods:
- Screening of the international ALPPS registry (NCT01924741; 2011-2014) for cases of monosegment ALPPS hepatectomy.
- Evaluation of lesion anatomy, indications, operative details, complications, survival, and recurrence in 12 selected patients.
Main Results:
- Twelve patients with unresectable bilobar colorectal liver metastases underwent monosegment ALPPS hepatectomy.
- Median hypertrophy of the liver remnant was 160% within 13 days. No mortality was observed, and liver failure cases recovered.
- At 14 months follow-up, 6 patients were tumor-free, while 6 experienced recurrence.
Conclusions:
- Monosegment liver resections are feasible with the ALPPS technique, representing a novel approach in liver surgery.
- The rapid hypertrophy induced by ALPPS supports these extreme resections.
- A new nomenclature based on the remnant segments is proposed for these procedures.
