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2016 ; 95
(24
): e3941
Nephropedia Template TP
gab.com Text
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An updated systematic review of the evolution of ALPPS and evaluation of its
advantages and disadvantages in accordance with current evidence
#MMPMID27311006
Cai YL
; Song PP
; Tang W
; Cheng NS
Medicine (Baltimore)
2016[Jun]; 95
(24
): e3941
PMID27311006
show ga
The main obstacle to achieving an R0 resection after a major hepatectomy is
inability to preserve an adequate future liver remnant (FLR) to avoid
postoperative liver failure (PLF). Associating liver partition and portal vein
ligation for staged hepatectomy (ALPPS) is a novel technique for resecting tumors
that were previously considered unresectable, and this technique results in a
vast increase in the volume of the FLR in a short period of time. However, this
technique continues to provoke heated debate because of its high mortality and
morbidity.The evolution of ALPPS and its advantages and disadvantages have been
systematically reviewed and evaluated in accordance with current evidence.
Electronic databases (PubMed and Medline) were searched for potentially relevant
articles from January 2007 to January 2016.ALPPS has evolved into various
modified forms. Some of these modified techniques have reduced the difficulty of
the procedure and enhanced its safety. Current evidence indicates that the
advantages of ALPPS are rapid hypertrophy of the FLR, the feasibility of the
procedure, and a higher rate of R0 resection in comparison to other techniques.
However, ALPPS is associated with worse major complications, more deaths, and
early tumor recurrence.Hepatobiliary surgeons should carefully consider whether
to perform ALPPS. Some modified forms of ALPPS have reduced the mortality and
morbidity of the procedure, but they cannot be recommended over the original
procedure currently. Portal vein embolization (PVE) is still the procedure of
choice for patients with a tumor-free FLR, and ALPPS could be used as a salvage
procedure when PVE fails. More persuasive evidence needs to be assembled to
determine whether ALPPS or two-stage hepatectomy (TSH) is better for patients
with a tumor involving the FLR. Evidence with regard to long-term oncological
outcomes is still limited. More meticulous comparative studies and studies of the
5-year survival rate of ALPPS could ultimately help to determine the usefulness
of ALPPS. Indications and patient selection for the procedure need to be
determined.