Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): Breaks the barrier between resectable and unresectable.

Abstract

Abstract: Liver failure is still the main issue for the post hepatectomy mortality. The main obstacle for hepatectomy is insufficient future liver remnant (FLR). Safety markers of hepatic resection are borderline liver function and sufficient volume of FLR. Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a new innovation to increase FLR to the desired volume permitting extended hepatectomy for patients with initially insufficient FLR. This article reviews the emergent and surgical aspect of ALPPS in comparison to traditional methods to increase FLR. Pathophysiology of liver hypertrophy following ALPPS and other methods are discussed in details. Outcome and prognosis are also reviewed through relevant literatures.

Key words: Portal vein embolization (PVE), Two-stage hepatectomy, Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS), future liver remnant (FLR)

References

[1] Skye C Mayo, Timothy M Pawlik, Current Management of Colorectal Hepatic
Metastasis, Expert Rev Gastroenterol Hepatol. 2009;3(2):131-144.
[2] Clavien, P.A., Petrowsky, H., DeOlivera, M.L., et al. Strategies for safer liver surgery and partial liver transplantation. N. Eng. J. Med. 2007; 356: 1545–1559.
[3] Kimberly A. Bertens, Jeffrey Hawel, Kalvin Lung, et al. ALPPS: Challenging the concept of unresectability – A systematic review. International Journal of Surgery, January 2015;13: 280-287.
[4] Garcea, G., Ong, S.L., and Maddern, G.J. Predicting liver failure following major hepatectomy. Dig. Liver Dis. 2009; 41: 798–806.
[5] Tanaka, K., Shimada, H., Matsuo, K., et al. Remnant liver regeneration after two-stage hepatectomy for multiple bilobar colorectal metastases. Eur. J. Surg. Oncol. 2007; 33: 329–335.
[6] Tucker, O.N. and Heaton, N. The “small for size” liver syndrome. Curr. Opin. Crit. Care. 2005; 11:150–155.
[7] T.M. Earl, W.C. Chapman, Conventional surgical treatment of hepatocellular carcinoma, Clinics in Liver Disease, 15 (2011), pp. 353–370.
[8] S. Truant, O. Oberlin, G. Sergent, et al. Remnant liver volume to body weight ratio > or =0.5%: a new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver, Journal of the American College of Surgeons, 204 (2007), pp. 22–33.
[9] Madoff, D.C., Abdalla, E.K., Gupta, S., 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: 215–225.
[10] Makuuchi, M., Thai, B.L., Takayasu, K., et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990; 107: 521–527.
[11] Nagino, M., Kamiya, J., Kanai, M., et al. Right trisegment portal vein embolization for biliary tract carcinoma: technique and clinical utility. Surgery. 2000; 127: 155–160.
[12] Ribero, D., Abdalla, E.K., Madoff, D.C., et al. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome.Br. J. Surg. 2007; 94: 1386–1394.
[13] Shindoh, J., Truty, M.J., Aloia, T.A., et al. Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant. J. Am. Coll. Surg. 2013; 216: 201–209.
[14] Jaeck, D., Oussoultzoglou, E., Rosso, E., et al. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann. Surg. 2004; 240: 1037–1051.
[15] Adam, R., Laurent, A., Azoulay, D., et al. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann. Surg. 2000; 232: 777–785.
[16] Abulkhir, A., Limongelli, P., Healey, A.J., et al. Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann. Surg. 2008; 247:49–57.
[17] Schnitzbauer, A.A., Lang, S.A., Goessmann, H., 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: 405–414.
[18] Schadde, E., Ardiles, V., Slankamenac, K., 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; 38:1510–1519.
[19] Shindoh, J., Vauthey, J.N., Zimmitti, G., 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; 217:126–134.
[20] Figueras, J. and Belghiti, J. The ALPPS approach: should we sacrifice basic therapeutic rules in the name of innovation?. World J. Surg. 2014; 38: 1520–1521.
[21] Jeroen De Jonge and Kim Marie Olthoff, Liver regeneration: mechanisms and clinical relevance, Blumgart’s Surgery of the Liver, Biliary tract and Pancreas, Elsevier, 5th edition, 2012:87-101.
[22] Guan-Qi Zhang, Zhi-Wei Zhang, Wan-Yee Lau, Xiao-Ping Chen, Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): A new strategy to increase resectability in liver surgery, International Journal of Surgery, Volume 12, Issue 5, May 2014, Pages 437–441.
[23] Aussilhou B, Lesurtel M, Sauvanet A, et al. Right portal vein ligation is as efficient as portal vein embolization to induce hypertrophy of the left liver remnant. J Gastrointest Surg. 2008;12:297–303.
[24] Broering DC, Hillert C, Krupski G, et al. Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg. 2002;6:905–913.
[25] Capussotti L, Muratore A, Baracchi F, et al. Portal vein ligation as an efficient method of increasing the future liver remnant volume in the surgical treatment of colorectal metastases. Arch Surg. 2008, 143:978–982.
[26] Hemming AW, Reed AI, Howard RJ, et al. Preoperative portal vein embolization for extended hepatectomy. Ann Surg. 2003;237(5),686–693.
[27] Maddof DC, Hicks ME, Abdalla EK, et al Portal vein embolization with polyvinyl alcohol particles and coils in preparation for major liver resection for hepatobiliary malignancy: safety and effectiveness— Study in 26 patients. Radiology. 2003;227(1)251-260.
[28] Lelpo, B., Caruso, R., Ferri, V., et al. ALPPS procedure: our experience and state of the art. Hepatogastroenterology.2013; 60: 2069–2075.
[29] Lelpo, B., Quijano, Y., and Vicente, E. Pearls and pitfalls on ALPPS procedure: new complications in a new technique. Updat. Surg. 2014; 66: 159–161.
[30] Robinson, S.M., Wilson, C.H., Burt, A.D., et al. Chemotherapy-associated liver injury in patients with colorectal liver metastases: a systematic review and meta-analysis. Ann. Surg. Oncol. 2012; 19: 4287–4299.
[31] Asencio, J.M., Vaquero, J., Olmedilla, L., and Garcia Sabrido, J.L. “Small-for-flow” syndrome: shifting the “size” paradigm. Med. Hypotheses. 2013; 80: 573–577.
[32] R. Adam, R. Miller, M. Pitombo, et al. Two-stage hepatectomy approach for initially unresectable colorectal hepatic metastases, Surgical Oncology Clinics of North America, 16 (2007), pp. 525–536.
[33] A. Brouquet, E.K. Abdalla, S. Kopetz, et al. High survival rate after two-stage resection of advanced colorectal liver metastases: response-based selection and complete resection define outcome, Journal of Clinical Oncology, 29 (2011), pp. 1083–1090.
[34] M. Narita, E. Oussoultzoglou, D. Jaeck, et al. Two-stage hepatectomy for multiple bilobar colorectal liver metastases, The British Journal of Surgery, 98 (2011), pp. 1463–1475.
[35] V. Pamecha, B. Nedjat-Shokouhi, K. Gurusamy, et al. Prospective evaluation of two-stage hepatectomy combined with selective portal vein embolisation and systemic chemotherapy for patients with unresectable bilobar colorectal liver metastases, Digestive Surgery, 25 (2008), pp. 387–393.
[36] B. Aussilhou, S. Dokmak, S. Faivre, et al. Preoperative liver hypertrophy induced by portal flow occlusion before major hepatic resection for colorectal metastases can be impaired by bevacizumab, Annals of Surgical Oncology, 16 (2009), pp. 1553–1559.
[37] R. Kianmanesh, A. Sauvanet, O. Hentic, et al. Two-step surgery for synchronous bilobar liver metastases from digestive endocrine tumors: a safe approach for radical resection, Annals of Surgery, 247 (2008), pp. 659–665.
[38] O. Scatton, G. Katsanos, O. Soubrane, Two-stage hepatectomy: tape it and hang it, while you can, World Journal of Surgery, 36 (2012), pp. 1647–1650.
[39] Orlando Jorge Martins Torres, Eduardo de Souza Martins Fernandes, Cassio Virgilio Cavalcante Oliveira, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): the Brazilian experience, ABCD Arq Bras Cir Dig 2013;26(1):40-43.
[40] Sala S, Ardiles V, Ulla M, et al. Our initial experience with ALPPS technique: encouraging results. Updates Surg. 2012, 64(3):167-172.
[41] Santibanes E, Alvarez FA, Ardiles V. How to avoid postoperative liver failure: A novel method. . World J Surg. 2012; 36:125–128.
[42] Santiba?es E, Clavien PA. Playing play-doh to prevent postoperative liver failure: the "ALPPS" approach. Ann Surg. 2012;255(3):415-417.
[43] O.J. Torres, J.M. Moraes-Junior, N.C. Lima e Lima, A.M. Moraes, Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): a new approach in liver resections, Arquivos brasileiros de cirurgia digestiva, 25 (2012), pp. 290–292.
[44] Wilms, C., Mueller, L., Lenk, C., et al. Comparative study of portal vein embolization versus portal vein ligation for induction of hypertrophy of the future liver remnant using a mini-pig model. Ann. Surg. 2008; 247: 825–834.
[45] Riehle, K.J., Dan, Y.Y., Campbell, J.S., and Fausto, N. New concepts in liver regeneration.J. Gastroenterol. Hepatol. 2011; 26: 203–212.
[46] J. Li, P. Girotti, I. Konigsrainer, et al. ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure? Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 17 (2013), pp. 956–961.
[47] F.A. Alvarez, V. Ardiles, R. Sanchez Claria, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks, Journal of Gastrointestinal Surgery, 17 (2013), pp. 814–821.
[48] M.A. Machado, F.F. Makdissi, R.C. Surjan, ALPPS procedure with the use of pneumoperitoneum, Annals of Surgical Oncology, 20 (2013), pp. 1491–1493.
[49] S. Dokmak, J. Belghiti, Which limits to the “ALPPS” approach? Annals of Surgery, 256 (2012), p. e6 (author reply e16–17).
[50] de Santibanes E, Alvarez FA, Ardiles V. How to Avoid Postoperative Liver Failure: A Novel Method. . World J Surg 2012; 36:125 - 128.
[51] G. Vennarecci, A. Laurenzi, G.B. Levi Sandri, et al. The ALPPS procedure for hepatocellular carcinoma, Eur J Surg Oncol, 40 (2014), pp. 982–988.
[52] Marcel Autran Machado MD, Fabio F. Makdissi MD, Rodrigo C. Surjan MD, ALPPS procedure with the use of pneumoperitoneum. Ann. Surg. Oncol. 2013 May; 20: 1491–1493.
[53] Machado, M.A., Makdissi, F.F., and Surjan, R.C. Totally laparoscopic ALPPS is feasible and may be worthwhile. Ann. Surg. 2012; 256: 13–19.
[54] Conrad, C., Shivathirthan, N., Camerlo, A., et al. Laparoscopic portal vein ligation with in situ liver split for failed portal vein embolization. Ann. Surg. 2012; 256: 14–17.
[55] Vyas S, Markar S, Partelli S, et al. Portal vein embolization and ligation for extended hepatectomy. Indian J Surg Oncol (2014) 5:30-42.