Chance and challenge of associating liver partition and portal vein ligation for staged hepatectomy

The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was first performed in 2007. The critical patient selection, timing to perform the second stage operation, and minimally invasive technique are three key factors for patient outcomes. The aim of this review is to...

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Bibliographic Details
Published in:Hepatobiliary & pancreatic diseases international 2019-06, Vol.18 (3), p.214-222
Main Authors: Xiang, Fei, Hu, Ze-Min
Format: Article
Language:English
Subjects:
Bile Duct Neoplasms - mortality
Bile Duct Neoplasms - pathology
Bile Duct Neoplasms - surgery
Carcinoma, Hepatocellular - mortality
Carcinoma, Hepatocellular - pathology
Carcinoma, Hepatocellular - surgery
Clinical Decision-Making
Colorectal liver metastasis
Colorectal Neoplasms - pathology
Hepatectomy
Hepatectomy - adverse effects
Hepatectomy - methods
Hepatectomy - mortality
Hepatocellular carcinoma
Humans
Klatskin Tumor - mortality
Klatskin Tumor - pathology
Klatskin Tumor - surgery
Ligation
Liver Neoplasms - mortality
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Liver Regeneration
Patient Selection
Perihilar cholangiocarcinoma
Portal vein
Portal Vein - pathology
Portal Vein - surgery
Postoperative Complications - etiology
Postoperative Complications - mortality
Recovery of Function
Risk Assessment
Risk Factors
Treatment Outcome
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Summary:The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was first performed in 2007. The critical patient selection, timing to perform the second stage operation, and minimally invasive technique are three key factors for patient outcomes. The aim of this review is to summarize published data on these three aspects. Studies were identified by searching PubMed for articles published from January 2007 to October 2018, using the keywords “associating liver partition and portal vein ligation for staged hepatectomy” or “ALPPS” or “in situ split”. Studies on colorectal liver metastasis (CRLM), perihilar cholangiocarcinoma (PHC), and hepatocellular carcinoma (HCC) indicated for ALPPS, cutoff values to determine the timing of stage 2, as well as modifications of ALPPS were included. The mortality of ALPPS for CRLM is declining, for PHC is high. In patients with HCC, essential hypertrophy makes the ALPPS safer. However, the degrees of fibrosis affect the hypertrophy. The future liver remnant volume is still the gold standard to start the second stage. Hepatobiliary scintigraphy plays an important role in quantitatively assessing liver function, whereas cutoff values need to be further calibrated. Less-invasive ALPPS modifications have increased and led to a decreased mortality. ALLPS improved the CRLM outcomes; ALPPS is feasible in patients with PHC after failure of portal vein embolization; ALPPS may be an option for HCC patients with major vascular invasion and thrombosis. The simplified and less-invasive ALPPS is the trend.
ISSN:1499-3872
DOI:10.1016/j.hbpd.2019.04.006