scholarly journals Rescue ALPPS: Intraoperative Conversion to ALPPS during Synchronous Resection of Rectal Cancer and Liver Metastasis

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Terence Jackson ◽  
Kelly A. Siegel ◽  
Christopher T. Siegel
Keyword(s):  
Liver Resection ◽  
Liver Metastasis ◽  
Portal Vein ◽  
Future Liver Remnant ◽  
Dropout Rate ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Patients At Risk ◽  
Synchronous Resection ◽  
Intraoperative Conversion

Future liver remnant (FLR) is the most important deciding factor in planning for liver resection. Portal vein embolization (PVE) was first introduced in the 1980s to induce liver hypertrophy, enabling removal of multiple/bilobar tumors. PVE was later combined with sequential hepatectomies with the aim of allowing the liver remnant to hypertrophy (15–20%) between procedures. However, the interval between the two procedures (3–8 weeks) put patients at risk for disease progression. With portal vein ligation alone or when combined with sequential hepatectomy, there is also a risk for inadequate liver hypertrophy because of intrahepatic portal collaterals leading to a high (19–30%) dropout rate. The ALPPS procedure (associating liver partition and portal vein ligation for staged hepatectomy) was recently developed as a feasible means to perform extensive/bilobar liver resections. It produces rapid, enormous hypertrophy of the remnant, making previously unresectable lesions resectable. Indications for ALPPS include any extensive liver resection with inadequate FLR. Here we present a novel indication for ALPPS as a rescue when inadequate FLR was faced intraoperatively, during a simultaneous resection of rectal primary and liver metastasis.

In situliver transection with portal vein ligation for rapid growth of the future liver remnant in two-stage liver resection

2012 ◽  
Vol 100 (3) ◽  
pp. 388-394 ◽  
Author(s):  
W. T. Knoefel ◽  
I. Gabor ◽  
A. Rehders ◽  
A. Alexander ◽  
M. Krausch ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Rapid Growth ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Two Stage ◽  
Liver Remnant ◽  
The Future

scholarly journals Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
F. Oldhafer ◽  
K. I. Ringe ◽  
K. Timrott ◽  
M. Kleine ◽  
W. Ramackers ◽  
...  
Keyword(s):  
Liver Resection ◽  
Ct Scan ◽  
Treatment Option ◽  
Intrahepatic Cholangiocarcinoma ◽  
Liver Tumors ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Typical Lesion ◽  
Intraoperative Conversion

Background. Surgical resection remains the best treatment option for intrahepatic cholangiocarcinoma (ICC). Two-stage liver resection combiningin situliver transection with portal vein ligation (ALPPS) has been described as a promising method to increase the resectability of liver tumors also in the case of ICC.Presentation of Case. A 46-year-old male patient presented with an ICC-typical lesion in the right liver. The indication for primary liver resection was set and planed as a right hepatectomy. In contrast to the preoperative CT-scan, the known lesion showed further progression in a macroscopically steatotic liver. Therefore, the decision was made to perform an ALPPS-procedure to avoid an insufficient future liver remnant (FLR). The patient showed an uneventful postoperative course after the first and second step of the ALPPS-procedure, with sufficient increase of the FLR. Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan.Discussion. The presented case demonstrates that an intraoperative conversion to an ALPPS-procedure is safely applicable when the FLR surprisingly seems to be insufficient.Conclusion. ALPPS should also be considered a treatment option in well-selected patients with ICC. However, the experience concerning the outcome of ALPPS in case of ICC remains fairly small.

Improved hepatocyte function of future liver remnant of cirrhotic rats after portal vein ligation: A bonus other than volume shifting

Surgery ◽  
2009 ◽  
Vol 145 (2) ◽  
pp. 202-211 ◽  
Author(s):  
Kun-Ju Lin ◽  
Chien-Hung Liao ◽  
Ing-Tsung Hsiao ◽  
Tzu-Chen Yen ◽  
Tse-Ching Chen ◽  
...  
Keyword(s):  
Portal Vein ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Liver Remnant

scholarly journals Folinic Acid Potentiates the Liver Regeneration Process after Selective Portal Vein Ligation in Rats

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 371
Author(s):  
Jorge Gutiérrez Sáenz de Santa María ◽  
Borja Herrero de la Parte ◽  
Gaizka Gutiérrez-Sánchez ◽  
Inmaculada Ruiz Montesinos ◽  
Sira Iturrizaga Correcher ◽  
...  
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Liver Regeneration ◽  
Folinic Acid ◽  
Hepatic Metastases ◽  
Future Liver Remnant ◽  
Control Group ◽  
Portal Vein Ligation ◽  
Nuclear Area ◽  
Liver Remnant

Liver resection remains the gold standard for hepatic metastases. The future liver remnant (FLR) and its functional status are two key points to consider before performing major liver resections, since patients with less than 25% FLR or a Child–Pugh B or C grade are not eligible for this procedure. Folinic acid (FA) is an essential agent in cell replication processes. Herein, we analyze the effect of FA as an enhancer of liver regeneration after selective portal vein ligation (PVL). Sixty-four male WAG/RijHsd rats were randomly distributed into eight groups: a control group and seven subjected to 50% PVL, by ligation of left portal branch. The treated animals received FA (2.5 m/kg), while the rest were given saline. After 36 h, 3 days or 7 days, liver tissue and blood samples were obtained. FA slightly but significantly increased FLR percentage (FLR%) on the 7th day (91.88 ± 0.61%) compared to control or saline-treated groups (86.72 ± 2.5 vs. 87 ± 3.33%; p < 0.01). The hepatocyte nuclear area was also increased both at 36 h and 7days with FA (61.55 ± 16.09 µm2, and 49.91 ± 15.38 µm2; p < 0.001). Finally, FA also improved liver function. In conclusion, FA has boosted liver regeneration assessed by FLR%, nuclear area size and restoration of liver function after PVL.

scholarly journals Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

2020 ◽  
Vol 27 (7) ◽  
pp. 2311-2318 ◽  
Author(s):  
Pim B. Olthof ◽  
◽  
Luca Aldrighetti ◽  
Ruslan Alikhanov ◽  
Matteo Cescon ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Liver Failure ◽  
Portal Vein Embolization ◽  
Future Liver Remnant ◽  
International Study ◽  
Perihilar Cholangiocarcinoma ◽  
Major Liver Resection ◽  
Biliary Leakage ◽  
Liver Remnant

Abstract Background Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p < 0.001 and p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p < 0.001), as was biliary leakage (10% vs. 35%, p < 0.01), intra-abdominal abscesses (19% vs. 34%, p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.

Portal vein ligation with alcohol injection – our first experiences

2019 ◽  
Vol 98 (9) ◽  
pp. 379-384
Keyword(s):  
Portal Vein ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Absolute Alcohol ◽  
Alcohol Injection ◽  
Liver Remnant ◽  
Second Stage ◽  
Right Hemihepatectomy

Introduction: Surgical resection of colorectal liver metastases is a gold standard treatment. The indication criteria still continue expanding. The future liver remnant volume (FLRV) remains the only limiting factor of the resection. Many methods have been discussed to increase the FLRV. Injection of absolute alcohol into the portal vein seems to be one of the most effective. Patients and methods: In 2018 we perioperatively injected 25 ml of absolute alcohol into the ligated right portal branch in 3 patients with colorectal liver metastases at our department. All patients were indicated for second-stage right hemihepatectomy. Results: The mean FLRV increase was 206.6 cm3 4−6 weeks after absolute alcohol injection. A transient elevation of transaminases was observed with spontaneous regression within 10 days from alcohol injection. There was no complication clearly associated with alcohol application. No liver failure was observed. No patient died. All three patients underwent second-stage right hemihepatectomy. Conclusion: Portal vein ligation with alcohol injection can be an uncomplicated and highly effective method to achieve FLRV hypertrophy.

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