Pushing the limit of liver regeneration - safety and survival after monosegment-ALPPS: systematic review and individual patient data meta-analysis
Background - Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has expanded and spearheaded development in hepatobiliary surgery. Monosegment-ALPPS tests liver regeneration limits and may present as the last feasible curative treatment option. - Methods - Electronic...
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| Main Authors: | , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2022
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| In: |
HPB
Year: 2022, Volume: 24, Issue: 3, Pages: 353-358 |
| ISSN: | 1477-2574 |
| DOI: | 10.1016/j.hpb.2021.06.427 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.hpb.2021.06.427 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S1365182X21006092 
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| Author Notes: | Anastasia Murtha-Lemekhova, Juri Fuchs, Erik Schulz, Anthe Sterkenburg, Pascal Probst & Katrin Hoffmann |
| Summary: | Background - Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has expanded and spearheaded development in hepatobiliary surgery. Monosegment-ALPPS tests liver regeneration limits and may present as the last feasible curative treatment option. - Methods - Electronic databases (MEDLINE, Web of Science, Google Scholar, Cochrane Library and WHO International Clinical Trials Registry Platform) were searched for publications on mono-ALPPS using a predefined strategy without date or language restrictions. Individual patient data was extracted and analyzed. - Results - 237 publications were identified. 19 patients were identified to have undergone mono-ALPPS. Primarily, mono-ALPPS has been utilized as curative treatment for CRLM (17 of 19 cases). Successful mono-ALPPS was possible in FLR above 8% SLV. All patients received either chemotherapy alone or in combination with radiotherapy prior to surgery. 8 of 19 patients experienced PHLF grade A or B. There was no in-hospital mortality described. Recurrent disease has occurred in 7 of 19 patients and 3 have died during follow-up. - Conclusion - Mono-ALPPS is an experimental procedure that provides a reasonably safe opportunity to curatively treat extensive liver malignancies in patients with FLR as low as 8% SLV. PHLF is the most prevalent complication in mono-ALPPS. Mono-ALPPS should be evaluated in a multicentral study setting. |
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| Item Description: | Available online 6 July 2021 Gesehen am 01.04.2022 |
| Physical Description: | Online Resource |
| ISSN: | 1477-2574 |
| DOI: | 10.1016/j.hpb.2021.06.427 |