Animal Models for Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS): Achievements and Future Perspectives

2017 ◽  
Vol 58 (3-4) ◽  
pp. 140-157 ◽  
Author(s):  
Andras Budai ◽  
Andras Fulop ◽  
Oszkar Hahn ◽  
Peter Onody ◽  
Tibor Kovacs ◽  
...  
Keyword(s):  
Animal Models ◽  
Portal Vein ◽  
Liver Regeneration ◽  
Liver Volume ◽  
Falciform Ligament ◽  
Large Animal ◽  
Portal Vein Ligation ◽  
Total Liver Volume ◽  
The Right ◽  
Staged Hepatectomy

Background: Since 2012, Associated Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has been standing in the limelight of modern liver surgery and numerous questions have been raised regarding this novel approach. On the one hand, ALPPS has proved to be a valuable method in the treatment of hepatic tumors, while on the other hand, there are many controversies, such as high mortality and morbidity rates. Further surgical research is essential for a better understanding of underlying mechanisms and for enhancing patient safety. Summary: Until recently, only 8 animal models have been created with the purpose to mimic ALPPS-induced liver regeneration. From these 7 are rodent (6 rat and 1 mouse) models, while only 1 is a large animal model, which uses pigs. In case of rodent models, portal flow deprivation of 75-90% is achieved via portal vein ligation leaving only the right (20-25%) or left median (10-15%) lobes portally perfused, while liver splitting in general is carried out positioned according to the falciform ligament. As for the swine model, the left lateral and medial lobes (70-75% of total liver volume) are portally ligated, and the right lateral lobe (accounting for 20-24% of the parenchyma) is partially resected in order to reach critical liver volume. Each model is capable of reproducing the accelerated liver regeneration seen in human cases. However, all species have significantly different liver anatomy compared with the human anatomic situation, making clinical translation somewhat difficult. Key Messages: Unfortunately, there are no perfect animal models available for ALPPS research. Small animal models are inexpensive and well suited for basic research, but may only provide limited translational potential to humans. Clinically large animal models may provide more relevant data, but currently no suitable one exists.

scholarly journals Preoperative Trans-catheter Arterial Chemoembolization and Laparoscopic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in Unresectable Hepatocellular Carcinoma – A Case Report

BioMedica ◽  
2021 ◽  
Vol 37 (2) ◽  
pp. 86-92
Author(s):  
Yilin Hu ◽  
Yanbing Shen ◽  
Dan Wang ◽  
Tingjia Cao
Keyword(s):  
Hepatocellular Carcinoma ◽  
Case Report ◽  
Portal Vein ◽  
Liver Volume ◽  
Postoperative Outcome ◽  
Portal Vein Ligation ◽  
The Right ◽  
Staged Hepatectomy ◽  
Arterial Chemoembolization

<p>Transcatheter arterial chemoembolization (TACE) is considered as a major method to treat hepatocellular carcinoma (HCC). Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been used to treat patients with advanced HCC. This case report documents the safety, efficacy, and feasibility of TACE and laparoscopic ALPPS to treat the unresectable HCC of the right liver with right intra-hepatic metastasis in a male patient. Percutaneous and trans-femoral artery TACE was performed preoperatively, and the ALPPS stage-I at the 4th week and stage-II after 14 days was carried out. Postoperative outcome was assessed after 180 days of follow-up. It is concluded that preoperative TACE and laparoscopic ALPPS offer a fine treatment alternative to the patients with insufficient residual liver volume and relatively-advanced and extensive HCC.</p>

scholarly journals Assessment of Liver Function Using 99mTc-Mebrofenin Hepatobiliary Scintigraphy in ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy)

2015 ◽  
Vol 9 (3) ◽  
pp. 353-360 ◽  
Author(s):  
Kasia P. Cieslak ◽  
Pim B. Olthof ◽  
Krijn P. van Lienden ◽  
Marc G. Besselink ◽  
Olivier R.C. Busch ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Volume ◽  
Postoperative Liver Failure ◽  
Portal Vein Ligation ◽  
Hepatobiliary Scintigraphy ◽  
Remnant Liver ◽  
Total Liver Volume ◽  
Second Stage ◽  
Staged Hepatectomy

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a new surgical technique for patients in whom conventional treatment is not feasible due to insufficient future remnant liver (FRL). During the first stage of ALPPS, accelerated hypertrophy of the FRL is induced by ligation of the portal vein and in situ split of the liver. In the second stage, the deportalized liver is removed when the FRL volume has reached ≥25% of total liver volume. However, FRL volume does not necessarily reflect FRL function. 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) with SPECT-CT is a quantitative test enabling regional assessment of parenchymal uptake function using a validated cut-off value for the prediction of postoperative liver failure (2.7%/min/m2). This paper describes the changes in FRL function and FRL volume in a 79-year-old patient diagnosed with metachronous colonic liver metastases who underwent ALPPS. We have observed a substantial difference between the increase in FRL volume and FRL function suggesting that HBS with SPECT-CT enables monitoring of the FRL function and could be a useful tool in the timing of resection in the second stage of the ALPPS procedure.

Safety and efficacy of right portal vein embolization in patients with prior left lateral liver resection

2021 ◽  
pp. 028418512110141
Author(s):  
Vincent Van den Bosch ◽  
Federico Pedersoli ◽  
Sebastian Keil ◽  
Ulf P Neumann ◽  
Christiane K Kuhl ◽  
...  
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Liver Function Tests ◽  
Complete Resection ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Function Tests ◽  
Staged Hepatectomy

Background In patients with bilobar metastatic liver disease, surgical clearance of both liver lobes may be achieved through multiple-stage liver resections. For patients with extensive disease, a major two-staged hepatectomy consisting of resection of liver segments II and III before right-sided portal vein embolization (PVE) and resection of segments V–VIII may be performed, leaving only segments IV ± I as the liver remnant. Purpose To describe the outcome following right-sided PVE after prior complete resection of liver segments II and III. Material and Methods In this retrospective study, 15 patients (mean age = 60.4 ± 9.3 years) with liver metastases from colorectal cancer (n = 14) and uveal melanoma (n = 1) who were scheduled to undergo a major two-stage hepatectomy, were included. Total liver volume (TLV) and volume of the future liver remnant (FLR) were measured on pre- and postinterventional computed tomography (CT) scans, and standardized FLR volumes (ratio FLR/TLV) were calculated. Patient data were retrospectively analyzed regarding peri- and postinterventional complications, with special emphasis on liver function tests. Results The mean standardized post-PVE FLR volume was 26.9% ± 6.4% and no patient developed hepatic insufficiency after the PVE. Based on FLR hypertrophy and liver function tests, all but one patient were considered eligible for the subsequent right-sided hepatectomy. However, due to local tumor progression, only 9/15 patients eventually proceeded to the second stage of surgery.   Conclusion Right-sided PVE was safe and efficacious in this cohort of patients who had previously undergone a complete resection of liver segments II and III as part of a major staged hepatectomy pathway leaving only segments IV(±I) as the FLR. 

scholarly journals Dynamic evaluation of liver volume and function in associating liver partition and portal vein ligation for staged hepatectomy

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e130
Author(s):  
E. Sparrelid ◽  
E. Jonas ◽  
A. Tzortzakakis ◽  
U. Dahlén ◽  
G. Murquist ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Volume ◽  
Portal Vein Ligation ◽  
Dynamic Evaluation ◽  
And Function ◽  
Staged Hepatectomy

scholarly journals Maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model

2018 ◽  
Vol 24 (10) ◽  
pp. 1107-1119 ◽  
Author(s):  
Yi-Fan Tong ◽  
Ning Meng ◽  
Miao-Qin Chen ◽  
Han-Ning Ying ◽  
Ming Xu ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Regeneration ◽  
Rat Model ◽  
Portal Vein Ligation ◽  
Staged Hepatectomy

scholarly journals Two-stage liver resection for intrahepatic cholangiocarcinoma

2020 ◽  
Vol 25 (1) ◽  
pp. 106-112
Author(s):  
A. V. Chzhao ◽  
B. N. Gurmikov ◽  
V. A. Vishnevsky ◽  
A. A. Olifir ◽  
Ya. Ya. Gavrilov ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Liver Volume ◽  
Liver Parenchyma ◽  
Portal Vein Ligation ◽  
Remnant Liver ◽  
Liver Remnant ◽  
Alternative Version ◽  
The Right ◽  
Cholangiocellular Cancer

The small remnant liver volume remains an urgent problem in liver resection surgery. The use of the method of twostage liver resection – the Associated Liver Partition and Portal vein ligation for Staged hepatectomy in most cases allows to solve this problem. However, this method is associated with a number of complications and limitations. The presented clinical observation shows the effectiveness of an alternative version of this technology – radiofrequency ablation of the liver parenchyma in the plane of the proposed resection with ligation of the right branch of the portal vein to increase the volume of the estimated liver remnant in intrahepatic cholangiocellular cancer.

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