Twitter time liver resection in one hospitalization with a more rapid liver hypertrophy.
The advantages of ALPPS are twitter time resection in one hospitalization, no drop out, the rapid hypertrophy and a more rapid postoperative chemotherapy . However, an increase in morbidity and mortality has been reported . Then, is mandatory a careful selection of patients. The ALPPS is a new type of two stage hepatectomy that allows achieving R0 resection in PTS otherwise considered unresecable in a single hospital stay without liver failure and in case of portal embolisation or ligature failure.
We have a limited experience with ALPPS in CRC Liver mets, with satisfactory oncological results, but at the expense of an increased (mainly biliary) morbidity.
Overall, we see ALPPS as an useful, valid but very demanding, technical resource, with two major drawbacks as far as CRC mets are involved:
- eventual (present) tendency to overuse
- loss of the "biological Met behavior" under interval chemo, risking to trade dropout for early recurrence,.
We had written our viewpoint on ALPPS in Annals of Surgery :
Ann Surg. 2012 Sep;256(3):e10; author reply e16-7. doi: 10.1097/SLA.0b013e318265fe4f.
Associating liver partition and portal vein ligation for staged hepatectomy: will the morbidity of an additional surgery be outweighed by better patient outcomes in the long-term?
Jain HA, Bharathy KG, Negi SS.
Still no high-grade evidence to make conclusive statement for both safety and long-term efficacy of ALPPS compared to usual two-step hepatectomy.
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