ALPPS is the combination of In situ split and portal ligation. It's a new surgical strategy,recently proposed and adopted by a few surgical groups all over the world, allowing extension of surgical indication in some liver disease (mainly colorectal liver metastasis but also some primary liver tumours). The preliminary results of such a method even if promising were strongly critcized during last IHPBA Congress in Paris. More studies and experiences are expected to clear some aspects of proposed method.
Firstly, no portal intervention to relieve portal hypertesion or for any other reason is desirable so, any expensive surgical option for the procedure would make no difference.
this is not about expensive methods, it is about giving otherwise non resectable patients a chance.
In our experience the procedure is good for HCC in non-cirrhotic liver and especially for cases with bilobar CRLM.
By the way, the correct acronym is ALPPS
It's an interesting technique which warrants further evaluation. However, the indications are scarce and will be even more so with the approriate use of local ablation methods to increase resectability (microwave - irreversible electroporation), though it will be a few years before these techniques have proven them selfs to the hbp-surgery community.
ALPPS is a method to induce a rapid hypertrophy of the remnant liver. It might provide chance of R0 resection in patients with several lesions and a small future liver remnant. As the hypertrophy develops in few days, and the surgery colud be completed quickly, can solve the problem of tumor progression found in other procedures to increase liver volume as portal vein embolization.
In our experience in patients with multiple CLM, this approach has achieved R0 resection in all the patients but is a technically very demanding procedure with important high grade morbility, as shown in published papers.
Outside my area of expertise. Ask a liver surgeon suggest Roger Berry: [email protected]
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.
I believe we are still on an "ALPPS boom", which will eventually lead to an adequate plateau of well established indications.
Overall, we see ALPPS as an useful, very demanding, technical resource, with two major drawbacks:
- eventual (present) tendency to overuse
- loss of the "biological Met behavior" under interval chemo, risking to trade dropout for early recurrence, as far as CRC mets are involved.
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.
ALPPS is good for patients who would otherwise be denied a curative procedure because of small remnant liver volume. One needs to select the patient well.
Rapid hypertrophy and reduced time interval before second stage procedure is promising as compared to portal vein embolisation.
I would think it needs more follow up reports however for now it is a good option for select group of patients.
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