Skip to main content
SpringerLink
Log in

Associated Liver Partition with Portal Vein Ligation for Staged Hepatectomy

  • Chapter
  • First Online:
GI Surgery Annual

Part of the book series: GI Surgery Annual ((GISA,volume 22))

  • 337 Accesses

Abstract

Complete resection of primary liver tumours and selected liver metastases offers patients the best chance of cure or long-term survival although it puts them at risk of postoperative liver failure (PLF), which remains the commonest cause of death after major hepatectomy [1]. An insufficient future liver remnant (FLR) either in terms of volume or quality is the main determinant of PLF. Most surgeons would accept a FLR of 25–30 % in patients with a normal liver, and 40 % or more in patients with steatosis, fibrosis or cirrhosis [1].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Garcea G, Ong SL, Maddern GJ. Predicting liver failure following major hepatectomy. Dig Liver Dis 2009;41:798–806.

    Article  CAS  PubMed  Google Scholar 

  2. Liu H, Zhu S. Present status and future perspectives of preoperative portal vein embolization. Am J Surg 2009;197:686–90.

    Article  PubMed  Google Scholar 

  3. Wicherts DA, Miller R, de Haas RJ, Bitsakou G, Vibert E, Veilhan LA, et al. Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg 2008;248:994–1005.

    Article  PubMed  Google Scholar 

  4. de Santibañes E, Clavien PA. Playing Play-Doh to prevent postoperative liver failure: The “ALPPS” approach. Ann Surg 2012;255:415–17.

    Article  PubMed  Google Scholar 

  5. Baumgart J, Lang S, Lang H. A new method for induction of liver hypertrophy prior to right trisectionectomy: A report of three cases, HPB 2011;13 (Suppl 2):71–2 (Abstract no. P0008L).

    Google Scholar 

  6. 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 left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 2012;255:405–14.

    Article  PubMed  Google Scholar 

  7. Dokmak S, Belghiti J. Which limits to the “ALPPS” approach? Ann Surg 2012;256:e6; author reply e16-e17.

    Google Scholar 

  8. Schlegel A, Lesurtel M, Melloul E, Limani P, Tschuor C, Graf R, et al. ALPPS: From human to mice highlighting accelerated and novel mechanisms of liver regeneration. Ann Surg 2014;260:839–46; discussion 846–7.

    Article  PubMed  Google Scholar 

  9. Sala S, Ardiles V, Ulla M, Alvarez F, Pekolj J, de Santibañes E. Our initial experience with ALPPS technique: Encouraging results. Updates Surg 2012;64:167–72.

    Article  PubMed  Google Scholar 

  10. Donati M, Stavrou GA, Oldhafer KJ. Current position of ALPPS in the surgical landscape of CRLM treatment proposals. World J Gastroenterol 2013;19:6548–54.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ratti F, Cipriani F, Gagliano A, Catena M, Paganelli M, Aldrighetti L. Defining indications to ALPPS procedure: Technical aspects and open issues. Updates Surg 2014;66:41–9.

    Article  PubMed  Google Scholar 

  12. Bertens KA, Hawel J, Lung K, Buac S, Pineda-Solis K, Hernandez-Alejandro R. ALPPS: challenging the concept of unresectability—a systematic review. Int J Surg 2015;13:280–7.

    Article  PubMed  Google Scholar 

  13. Schadde E, Schnitzbauer AA, Tschuor C, Raptis DA, Bechstein WO, Clavien PA. Systematic review and meta-analysis of feasibility, safety, and efficacy of a novel procedure: Associating liver partition and portal vein ligation for staged hepatectomy. Ann Surg Oncol 2014 Dec 2 (Epub ahead of print).

    Google Scholar 

  14. Schadde E, Ardiles V, Slankamenac K, Tschuor C, Sergeant G, Amacker N, et al. 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;38:1510–19.

    Article  PubMed  Google Scholar 

  15. Schadde E, Ardiles V, Robles-Campos R, Malago M, Machado M, Hernandez-Alejandro R, et al. Early survival and safety of ALPPS: First report of the International ALPPS registry. Ann Surg 2014;260:829–36; discussion 836–8.

    Article  PubMed  Google Scholar 

  16. Hernandez-Alejandro R, Bertens KA, Pineda-Solis K, Croome KP. Can we improve the morbidity and mortality associated with the associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) procedure in the management of colorectal liver metastases? Surgery 2015;157:194–201.

    Article  PubMed  Google Scholar 

  17. Alvarez FA, Ardiles V, Sanchez Claria R, Pekolj J, de Santibañes E. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): Tips and tricks. J Gastrointest Surg 2013;17:814–21.

    Article  PubMed  Google Scholar 

  18. Oldhafer KJ, Donati M, Jenner RM, Stang A, Stavrou GA. ALPPS for patients with colorectal liver metastases: Effective liver hypertrophy, but early tumor recurrence. World J Surg 2014;38:1504–9.

    Article  PubMed  Google Scholar 

  19. Truant S, Scatton O, Dokmak S, Regimbeau JM, Lucidi V, Laurent A, et al. e-HPBchir Study Group from the Association de Chirurgie Hépato-Biliaire et de Transplantation (ACHBT). Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): Impact of the inter-stages course on morbidity-mortality and implications for management. Eur J Surg Oncol 2015;41:674–82.

    Article  CAS  PubMed  Google Scholar 

  20. Li J, Girotti P, Konigsrainer I, Ladurner R, Konigsrainer A, Nadalin S. ALPPS in right trisectionectomy: A safe procedure to avoid postoperative liver failure? J Gastrointest Surg 2013;17:956–61.

    Article  PubMed  Google Scholar 

  21. Nadalin S, Capoblanco I, Li J, Girotti P, Konigsrainer I, Konigsrainer A. Indications and limitations for Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS). Lessons learned from 15 cases at a single centre. Z Gastroenterol 2014;52:35–2.

    Article  CAS  PubMed  Google Scholar 

  22. Robles R, Parrilla P, López-Conesa A, Brusadin R, de la Peña J, Fuster M, et al. Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure. Br J Surg 2014;101:1129–34; discussion 1134.

    Article  CAS  PubMed  Google Scholar 

  23. Torres OJM, Fernandes EDM, Oliviera CVC, Lima CX, Waechler FL, Moraes-Jumor JMA, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): The Brazilian experience. ABCD Arq Bras Cir Dig 2013;26:40–3.

    Article  PubMed  Google Scholar 

  24. Alvarez FA, Ardiles V, de Santibañes M, Pekolj J, de Santibañes E. Associating liver partition and portal vein ligation for staged hepatectomy offers high oncological feasibility with adequate patient safety: A prospective study at a single center. Ann Surg 2015;261:723–32.

    Article  PubMed  Google Scholar 

  25. Petrowsky H, Györi G, de Oliveira M, Lesurtel M, Clavien PA. Is partial-ALPPS safer than ALPPS? A single-center experience. Ann Surg 2015;261:e90–2.

    Article  PubMed  Google Scholar 

  26. Machado MA, Makdissi FF, Surjan RC. ALPPS procedure with the use of pneumoperitoneum. Ann Surg Oncol 2013; 20: 1491–3.

    Article  PubMed  Google Scholar 

  27. Machado MA, Makdissi FF, Surjan RC. Totally laparoscopic ALPPS is feasible and may be worthwhile. Ann Surg 2012;256:e13; author reply e16–e19.

    Google Scholar 

  28. Gauzolino R, Castagnet M, Blanleuil ML, Richer JP. The ALPPS technique for bilateral colorectal metastases: Three “variations on a theme”. Updates Surg 2013;65:141–8.

    Article  PubMed  Google Scholar 

  29. Schadde E, Malagó M, Hernandez-Alejandro R, Li J, Abdalla E, Ardiles V, et al. Monosegment ALPPS hepatectomy: Extending resectability by rapid hypertrophy. Surgery 2015;157:676–89.

    Article  PubMed  Google Scholar 

  30. Li J, Kantas A, Ittrich H, Koops A, Achilles EG, Fischer L, et al. Avoid “All-Touch” by hybrid ALPPS to achieve oncological efficacy. Ann Surg 2014 Jul 28. (Epub ahead of print)

    Google Scholar 

  31. Tschuor Ch, Croome KP, Sergeant G, Cano V, Schadde E, Ardiles V, et al. Salvage parenchymal liver transection for patients with insufficient volume increase after portal vein occlusion—an extension of the ALPPS approach. Eur J Surg Oncol 2013;39:1230–5.

    Article  PubMed  Google Scholar 

  32. Gall TM, Sodergren MH, Frampton AE, Fan R, Spalding DR, Habib NA, et al. Radio-frequency-assisted liver partition with portal vein ligation (RALPP) for liver regeneration. Ann Surg 2015;261:e45–e46.

    Article  PubMed  Google Scholar 

  33. Gringeri E, Boetto R, D’Amico FE, Bassi D, Cillo U. Laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS): A minimally invasive first-step approach. Ann Surg 2015;261:e42–e43.

    Article  PubMed  Google Scholar 

  34. Madoff DC, Abdalla EK, Gupta S, Wu TT, Morris JS, Denys A, et al. Transhepatic ipsilateral right portal vein embolization extended to segment IV: Improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol 2005;16 (2 Pt 1):215–25.

    Article  PubMed  Google Scholar 

  35. Kokudo N, Shindoh J. How can we safely climb the ALPPS? Updates Surg 2013;65:175–7.

    Article  PubMed  Google Scholar 

  36. Abulkhir A, Limongelli P, Healey AJ, Damrah O, Tait P, Jackson J, et al. Preoperative portal vein embolization for major liver resection: A meta-analysis. Ann Surg 2008;247:49–57.

    Article  PubMed  Google Scholar 

  37. Shindoh J, Vauthey JN, Zimmitti G, Curley SA, Huang SY, Mahvash A, et al. Analysis of the efficacy 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;217:126–33; discussion 133–4.

    Article  PubMed  Google Scholar 

  38. Ratti F, Schadde E, Masetti M, Massani M, Zanello M, Serenari M, et al. Strategies to increase the resectability of patients with colorectal liver metastases: A multi-center case-match analysis of ALPPS and conventional two-stage hepatectomy. Ann Surg Oncol 2015;22:1933–42.

    Article  PubMed  Google Scholar 

  39. Figueras J, Belghiti J. The ALPPS approach: Should we sacrifice basic therapeutic rules in the name of innovation? World J Surg 2014;38:1520–1.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. National Foundation for Liver Research, Global Hospital, Chennai, 600100, Tamil Nadu, India

    A. Rahim Dabora, Anand Bharatan & Sanjay Govil

Authors
  1. A. Rahim Dabora
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anand Bharatan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sanjay Govil
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India

    Peush Sahni

  2. Department of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India

    Sujoy Pal

Rights and permissions

Reprints and permissions

Copyright information

© 2015 T.K. Chattopadhyay

About this chapter

Cite this chapter

Dabora, A.R., Bharatan, A., Govil, S. (2015). Associated Liver Partition with Portal Vein Ligation for Staged Hepatectomy. In: Sahni, P., Pal, S. (eds) GI Surgery Annual. GI Surgery Annual, vol 22. Springer, Singapore. https://doi.org/10.1007/978-981-10-2010-0_8

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-2010-0_8

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-2009-4

  • Online ISBN: 978-981-10-2010-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation