10th Anniversary of ALPPS—Lessons Learned and quo Vadis

作者：Hauke Lang, Eduardo de Santibáñes, Hans J. Schlitt, Massimo Malagó, Thomas van Gulik, Marcel Autran C. Machado, Elio Jovine, Stefan Heinrich, Giuseppe Maria Ettorre, Albert Chan, Roberto Hernandez‐Alejandro, R Robles, Per Sandström, Michael Linecker, Pierre-Alain Clavien · 发表于：Annals of Surgery · 年份：2018 · DOI：10.1097/sla.0000000000002797 · 被引用次数：125 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Organ Transplantation Techniques and Outcomes、Cholangiocarcinoma and Gallbladder Cancer Studies

OBJECTIVE: Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has been tested in various indications and clinical scenarios, leading to steady improvements in safety. This report presents the current status of ALPPS. SUMMARY BACKGROUND DATA: ALPPS offers improved resectability, but drawbacks are regularly pointed out regarding safety and oncologic benefits. METHODS: During the 12th biennial congress of the European African-Hepato-Pancreato-Biliary Association (Mainz, Germany, May 23-26, 2017) an expert meeting "10th anniversary of ALPP" was held to discuss indications, management, mechanisms of regeneration, as well as pitfalls of this novel technique. The aim of the meeting was to make an inventory of what has been achieved and what remains unclear in ALPPS. RESULTS: Precise knowledge of liver anatomy and its variations is paramount for success in ALPPS. Technical modifications, mainly less invasive approaches like partial, mini- or laparoscopic ALPPS, mostly aiming at minimizing the extensiveness of the first-stage procedure, are associated with improved safety. In fibrotic/cirrhotic livers the degree of future liver remnant hypertrophy after ALPPS appears some less than that in noncirrhotic. Recent data from the only prospective randomized controlled trial confirmed significant higher resection rates in ALPPS with similar peri-operative morbidity and mortality rates compared with conventional 2-stage hepatectomy including portal vein emboli...