Associating liver partition and portal vein ligation for staged hepatectomy: An emerging paradigm? Literature review apr
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O RIGINAL A R T I CL E
Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy: An Emerging Paradigm? Literature Review Apropos of the First Case in Greece A. Papalampros, M.G. Vailas, E. Felekouras, S. Orfanos, C. Vergadis, D. Schizas, T. Liakakos, J. Griniatsos
Abstract Introduction - Aim: Colorectal carcinoma (CRC) is the third most common cancer in the Western world. Radical
resection of liver metastases remains the only curative option. Postoperative liver failure has become the main concern because of insufficient future liver remnant (FLR). Several techniques have evolved to induce liver hypertrophy of the FLR prior to hepatectomy in primarily unresectable liver tumours. An innovative two-staged technique named as associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has shown promising results. Herein, we report the first case of ALPPS in the Greek population ever to be reported, and also provide a review of the current literature regarding this novel surgical procedure. Method: A 70-year-old male presented with a history of altered bowel habits and haematochezia. Colonoscopy revealed a sigmoid adenocarcinoma. Computed tomography (CT) disclosed bilobar liver metastases. The initial decision of the multidisciplinary team was to use upfront chemotherapy. Magnetic resonance imaging (MRI) and CT of the abdomen showed minimal response after completion of the chemotherapy regimen. A right trisectionectomy via the ALPPS procedure and a simultaneous left hemicolectomy were performed. A systematic literature search was conducted with regard to other cases of ALPPS. Results: The patient’s postoperative course was complicated by post hepatectomy Grade A liver failure, according
to the International Study Group of Liver Surgery definition. Conclusions: ALPPS is a novel innovative procedure that has generated great enthusiasm in the field of hepatobili-
ary surgery. Indications for ALPPS should be re-evaluated and a common consensus reached among centres for a standardized surgical technique. Key words: ALPPS; associating liver partition and portal vein ligation for staged hepatectomy; colorectal carcinoma; in situ split; liver metastases
Introduction - Aim Colorectal carcinoma (CRC) is the third most common cancer in the Western world irrespective of gender. Twentyfive per cent of patients have detectable synchronous liver
A. Papalampros, M.G. Vailas First Surgical Department, Athens University School of Medicine, Authors equally contributed E. Felekouras, S. Orfanos, D. Schizas, T. Liakakos, J. Griniatsos First Surgical Department, Athens University School of Medicine C. Vergadis Radiology Department “Laiko” General Hospital, Agiou Thoma 17, Athens, Greece Corresponding author: Michail G. Vailas First Surgical Department, Athens University School of Medicine, “Laiko” General Hospital, Agiou Thoma 17, Athens, 11527, Greece, Tel.: +30 6976815514, e-mail: [email protected], Received 18 Dec 2015; Accepted 05 Feb 2016
Hellenic Journal of Surgery 88
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