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Pierre-alain Clavien - One of the best experts on this subject based on the ideXlab platform.
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Renal Impairment Is Associated with Reduced Outcome After Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy
Journal of Gastrointestinal Surgery, 2019Co-Authors: Tim Reese, Eduardo De Santibanes, Mohammad H. Fard-aghaie, Georgios Makridis, Alexandros Kantas, Kim C. Wagner, Massimo Malagó, Richardo Robles-campos, Roberto Hernandez-alejandro, Pierre-alain ClavienAbstract:Background Impaired postoperative renal function is associated with increased morbidity and mortality after liver resection. The role of impaired renal function in the two-stage hepatectomy setting of associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) is unknown. Methods An international multicenter cohort of ALPPS patients captured in the ALPPS Registry was analyzed. Particular attention was drawn to the renal function in the interstage interval to determine outcome after stage 2 surgery. Interstage renal impairment (RI) was defined as an increase of serum creatinine of ≥ 0.3 mg/dl referring to a preoperative value or an increase of serum creatinine of ≥ 1.5× of the preoperative value on the fifth postoperative day after stage 1. Results A total of 705 patients were identified of which 7.5% had an interstage RI. Patients developing an interstage RI were significantly older. During stage 1, a longer operation time, higher rate of intraoperative transfusions, and additional procedures were observed in patients that developed interstage RI. After stage 1, interstage RI patients had more major complications and higher interstage mortality (1% vs. 8%, p < 0.001). Furthermore, these patients developed more and severe complications after completion of stage 2. Mortality of patients with interstage RI was 38% vs. 8% without interstage RI. In 41% of patients with interstage RI, the renal function recovered before stage 2; however, the mortality after stage 2 remained 28% in those patients. Risk factors for the development of an interstage RI were age over 67 years, prolonged operative time, and additional procedure during stage 1. Conclusion This study shows that interstage RI is a predictor for interstage and post-stage 2 morbidity and perioperative mortality. The causality of impaired renal function on outcome, however, remains unknown. Interstage RI may directly cause adverse outcome but may also be a surrogate marker for major complications.
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survival after associating liver partition and portal Vein Ligation for staged hepatectomy alpps for advanced colorectal liver metastases a case matched comparison with palliative systemic therapy
Surgery, 2017Co-Authors: Pim B. Olthof, René Adam, Pierre-alain Clavien, Victoria Ardiles, Michael Linecker, Joost Huiskens, Dennis A Wicherts, Pablo E Huespe, Ricardo Roblescampos, Miriam KoopmanAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment. Methods All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival. Results Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and Conclusion Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
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survival after associating liver partition and portal Vein Ligation for staged hepatectomy alpps for advanced colorectal liver metastases a case matched comparison with palliative systemic therapy
Surgery, 2017Co-Authors: Pim B. Olthof, René Adam, Pierre-alain Clavien, Victoria Ardiles, Michael Linecker, Joost Huiskens, Dennis A Wicherts, Pablo E Huespe, Ricardo Roblescampos, Miriam KoopmanAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment. Methods All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival. Results Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and P = .002). Median disease-free survival was 6 months compared to 12 months ( P P = .088). Conclusion Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
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meta analysis of associating liver partition with portal Vein Ligation and portal Vein occlusion for two stage hepatectomy
British Journal of Surgery, 2016Co-Authors: Dilmurodjon Eshmuminov, Mickael Lesurtel, Dimitri A Raptis, Michael Linecker, Andrea Wirsching, Pierre-alain ClavienAbstract:Background Discussion is ongoing regarding whether associating liver partition with portal Vein Ligation for staged hepatectomy (ALPPS) or portal Vein occlusion is better in staged hepatectomy. The aim of this study was to compare available strategies using a two-stage approach in extended hepatectomy. Methods A literature search was performed in MEDLINE, Scopus, the Cochrane Library and Embase, and additional articles were identified by hand searching. Data from the international ALPPS registry were extracted. Clinical studies reporting volumetric changes, mortality, morbidity, feasibility of the second stage and tumour-free resection margins (R0) in two-stage hepatectomy were included. Results Ninety studies involving 4352 patients, including 320 from the ALPPS registry, met the inclusion criteria. Among these, nine studies (357 patients) reported on comparisons with other strategies. In the comparison of ALPPS versus portal Vein embolization (PVE), ALPPS was associated with a greater increase in the future liver remnant (76 versus 37 per cent; P < 0·001) and more frequent completion of stage 2 (100 versus 77 per cent; P < 0·001). Compared with PVE, ALPPS had a trend towards higher morbidity (73 versus 59 per cent; P = 0·16) and mortality (14 versus 7 per cent; P = 0·19) after stage 2. In the non-comparative studies, complication rates were 39 per cent in the PVE group, 47 per cent in the portal Vein Ligation (PVL) group and 70 per cent in the ALPPS group. After stage 2, mortality rates were 5, 7 and 12 per cent respectively. Conclusion ALPPS is associated with greater future liver remnant hypertrophy and a higher rate of completion of stage 2, but this may be at the price of greater morbidity and mortality.
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systematic review and meta analysis of feasibility safety and efficacy of a novel procedure associating liver partition and portal Vein Ligation for staged hepatectomy
Annals of Surgical Oncology, 2015Co-Authors: Erik Schadde, Dimitri A Raptis, Andreas A Schnitzbauer, Christoph Tschuor, W O Bechstein, Pierre-alain ClavienAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) is a novel strategy to resect liver tumors despite the small size of the liver remnant. It is an hepatectomy in two stages, with PVL and parenchymal transection during the first stage, which induces rapid growth of the remnant liver exceeding any other technique. Despite high postoperative morbidity and mortality in most reports, the technique was adopted by a number of surgeons.
Pim B. Olthof - One of the best experts on this subject based on the ideXlab platform.
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rapid liver hypertrophy after portal Vein occlusion correlates with the degree of collateralization between lobes a study in pigs
Journal of Gastrointestinal Surgery, 2018Co-Authors: Rebecca A. Deal, Pim B. Olthof, Charles Frederiks, Lauren Williams, Konstantin Dirscherl, Xavier M Keutgen, Edie Y Chan, Daniel J Deziel, Martin Hertl, Erik SchaddeAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) induces more rapid liver growth than portal Vein Ligation (PVL). Transection of parenchyma in ALPPS may prevent the formation of collaterals between lobes. The aim of this study was to determine if abrogating the formation of collaterals through parenchymal transection impacted growth rate.
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hepatobiliary scintigraphy to evaluate liver function in associating liver partition and portal Vein Ligation for staged hepatectomy liver volume overestimates liver function
Surgery, 2017Co-Authors: Pim B. Olthof, Erik Schadde, Pablo E Huespe, Federico Tomassini, Stephanie Truant, Francoisrene Pruvot, Roberto Troisi, Carlos Castro, Rimma Axelsson, Ernesto SparrelidAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) induces a rapid and extensive increase in liver volume. The functional quality of this hypertrophic response has been called into question because ALPPS is associated with a substantial incidence of liver failure and high perioperative mortality. This multicenter study aimed to evaluate functional liver regeneration in contrast to volumetric liver regeneration in ALPPS, using technetium-99m hepatobiliary scintigraphy and computed tomography volumetry, respectively. Methods Patients who underwent ALPPS and hepatobiliary scintigraphy in 6 centers were included. Hepatobiliary scintigraphy data were analyzed centrally at the Academic Medical Center in Amsterdam according to established protocols. Increase in liver function as measured by hepatobiliary scintigraphy after stage 1 of ALPPS was compared with the increase in liver volume. In addition, we analyzed the impact of liver function and volume on postoperative outcomes including liver failure, morbidity, and mortality. Results In 60 patients, future liver remnant volume increased by a median 78% (interquartile range 48–110) during a median 8 (interquartile range 6–14) days after stage 1, while function as measured by hepatobiliary scintigraphy increased by a median 29% (interquartile range 1–55) throughout 7 days (interquartile range 6–10) in the 27 patients with paired measurements. After stage 2 of ALPPS, liver failure occurred in 5/60 (8%) patients, severe complications in 24/60 (40%), and mortality occurred in 4/60 (7%). Conclusion In ALPPS, volumetry overestimates liver function as measured by hepatobiliary scintigraphy and may be responsible for the high rate of liver failure. Quantitative liver function tests are highly recommended to avoid post hepatectomy liver failure.
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survival after associating liver partition and portal Vein Ligation for staged hepatectomy alpps for advanced colorectal liver metastases a case matched comparison with palliative systemic therapy
Surgery, 2017Co-Authors: Pim B. Olthof, René Adam, Pierre-alain Clavien, Victoria Ardiles, Michael Linecker, Joost Huiskens, Dennis A Wicherts, Pablo E Huespe, Ricardo Roblescampos, Miriam KoopmanAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment. Methods All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival. Results Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and Conclusion Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
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survival after associating liver partition and portal Vein Ligation for staged hepatectomy alpps for advanced colorectal liver metastases a case matched comparison with palliative systemic therapy
Surgery, 2017Co-Authors: Pim B. Olthof, René Adam, Pierre-alain Clavien, Victoria Ardiles, Michael Linecker, Joost Huiskens, Dennis A Wicherts, Pablo E Huespe, Ricardo Roblescampos, Miriam KoopmanAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment. Methods All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival. Results Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and P = .002). Median disease-free survival was 6 months compared to 12 months ( P P = .088). Conclusion Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
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Assessment of Liver Function Using 99mTc-Mebrofenin Hepatobiliary Scintigraphy in ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy)
Karger Publishers, 2015Co-Authors: Kasia P. Cieslak, Pim B. Olthof, Krijn P. Van Lienden, Marc G. Besselink, Olivier R.c. Busch, Thomas M. Van Gulik, Roelof J. BenninkAbstract: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
Erik Schadde - One of the best experts on this subject based on the ideXlab platform.
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rapid liver hypertrophy after portal Vein occlusion correlates with the degree of collateralization between lobes a study in pigs
Journal of Gastrointestinal Surgery, 2018Co-Authors: Rebecca A. Deal, Pim B. Olthof, Charles Frederiks, Lauren Williams, Konstantin Dirscherl, Xavier M Keutgen, Edie Y Chan, Daniel J Deziel, Martin Hertl, Erik SchaddeAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) induces more rapid liver growth than portal Vein Ligation (PVL). Transection of parenchyma in ALPPS may prevent the formation of collaterals between lobes. The aim of this study was to determine if abrogating the formation of collaterals through parenchymal transection impacted growth rate.
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hepatobiliary scintigraphy to evaluate liver function in associating liver partition and portal Vein Ligation for staged hepatectomy liver volume overestimates liver function
Surgery, 2017Co-Authors: Pim B. Olthof, Erik Schadde, Pablo E Huespe, Federico Tomassini, Stephanie Truant, Francoisrene Pruvot, Roberto Troisi, Carlos Castro, Rimma Axelsson, Ernesto SparrelidAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) induces a rapid and extensive increase in liver volume. The functional quality of this hypertrophic response has been called into question because ALPPS is associated with a substantial incidence of liver failure and high perioperative mortality. This multicenter study aimed to evaluate functional liver regeneration in contrast to volumetric liver regeneration in ALPPS, using technetium-99m hepatobiliary scintigraphy and computed tomography volumetry, respectively. Methods Patients who underwent ALPPS and hepatobiliary scintigraphy in 6 centers were included. Hepatobiliary scintigraphy data were analyzed centrally at the Academic Medical Center in Amsterdam according to established protocols. Increase in liver function as measured by hepatobiliary scintigraphy after stage 1 of ALPPS was compared with the increase in liver volume. In addition, we analyzed the impact of liver function and volume on postoperative outcomes including liver failure, morbidity, and mortality. Results In 60 patients, future liver remnant volume increased by a median 78% (interquartile range 48–110) during a median 8 (interquartile range 6–14) days after stage 1, while function as measured by hepatobiliary scintigraphy increased by a median 29% (interquartile range 1–55) throughout 7 days (interquartile range 6–10) in the 27 patients with paired measurements. After stage 2 of ALPPS, liver failure occurred in 5/60 (8%) patients, severe complications in 24/60 (40%), and mortality occurred in 4/60 (7%). Conclusion In ALPPS, volumetry overestimates liver function as measured by hepatobiliary scintigraphy and may be responsible for the high rate of liver failure. Quantitative liver function tests are highly recommended to avoid post hepatectomy liver failure.
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systematic review and meta analysis of feasibility safety and efficacy of a novel procedure associating liver partition and portal Vein Ligation for staged hepatectomy
Annals of Surgical Oncology, 2015Co-Authors: Erik Schadde, Dimitri A Raptis, Andreas A Schnitzbauer, Christoph Tschuor, W O Bechstein, Pierre-alain ClavienAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) is a novel strategy to resect liver tumors despite the small size of the liver remnant. It is an hepatectomy in two stages, with PVL and parenchymal transection during the first stage, which induces rapid growth of the remnant liver exceeding any other technique. Despite high postoperative morbidity and mortality in most reports, the technique was adopted by a number of surgeons.
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alpps offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional staged hepatectomies results of a multicenter analysis
World Journal of Surgery, 2014Co-Authors: Erik Schadde, Victoria Ardiles, Christoph Tschuor, Roberto Hernandezalejandro, Ksenija Slankamenac, Gregory Sergeant, Nadja Amacker, J Baumgart, Kris P Croome, H LangAbstract:Background Portal Vein occlusion to increase the size of the future liver remnant (FLR) is well established, using portal Vein Ligation (PVL) or embolization (PVE) followed by resection 4–8 weeks later. Associating liver partition with portal Vein Ligation for staged hepatectomy (ALPPS) combines PVL and complete parenchymal transection, followed by hepatectomy within 1–2 weeks. ALPPS has been recently introduced but remains controversial. We compare the ability of ALPPS versus PVE or PVL for complete tumor resection.
René Adam - One of the best experts on this subject based on the ideXlab platform.
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survival after associating liver partition and portal Vein Ligation for staged hepatectomy alpps for advanced colorectal liver metastases a case matched comparison with palliative systemic therapy
Surgery, 2017Co-Authors: Pim B. Olthof, René Adam, Pierre-alain Clavien, Victoria Ardiles, Michael Linecker, Joost Huiskens, Dennis A Wicherts, Pablo E Huespe, Ricardo Roblescampos, Miriam KoopmanAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment. Methods All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival. Results Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and Conclusion Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
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survival after associating liver partition and portal Vein Ligation for staged hepatectomy alpps for advanced colorectal liver metastases a case matched comparison with palliative systemic therapy
Surgery, 2017Co-Authors: Pim B. Olthof, René Adam, Pierre-alain Clavien, Victoria Ardiles, Michael Linecker, Joost Huiskens, Dennis A Wicherts, Pablo E Huespe, Ricardo Roblescampos, Miriam KoopmanAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment. Methods All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival. Results Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and P = .002). Median disease-free survival was 6 months compared to 12 months ( P P = .088). Conclusion Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
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outcome after associating liver partition and portal Vein Ligation for staged hepatectomy and conventional two stage hepatectomy for colorectal liver metastases
British Journal of Surgery, 2016Co-Authors: Marc Antoine Allard, René Adam, Eric Vibert, Katsunori Imai, Castro C BenitezAbstract:Background Although associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) has been increasingly adopted by many centres, the oncological outcome for colorectal liver metastases compared with that after two-stage hepatectomy is still unknown. Methods Between January 2010 and June 2014, all consecutive patients who underwent either ALPPS or two-stage hepatectomy for colorectal liver metastases in a single institution were included in the study. Morbidity, mortality, disease recurrence and survival were compared. Results The two groups were comparable in terms of clinicopathological characteristics. ALPPS was completed in all 17 patients, whereas the second-stage hepatectomy could not be completed in 15 of 41 patients. Ninety-day mortality rates for ALPPS and two-stage resection were 0 per cent (0 of 17) versus 5 per cent (2 of 41) (P = 0·891). Major complication rates (Clavien grade at least III) were 41 per cent (7 of 17) and 39 per cent (16 of 41) respectively (P = 0·999). Overall survival was significantly lower after ALPPS than after two-stage hepatectomy: 2-year survival 42 versus 77 per cent respectively (P = 0·006). Recurrent disease was more often seen in the liver in the ALPPS group. Salvage surgery was less often performed after ALPPS (2 of 8 patients) than after two-stage hepatectomy (10 of 17). Conclusion Although major complication and 90-day mortality rates of ALPPS were similar to those of two-stage hepatectomy, overall survival was significantly lower following ALPPS.
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spontaneous splenorenal shunt in liver transplantation results of left renal Vein Ligation versus renoportal anastomosis
Transplantation, 2015Co-Authors: Nicolas Golse, René Adam, Petru Bucur, Francois Faitot, Mohamed Bekheit, Gabriella Pittau, O Ciacio, Antonio Sa Cunha, Denis Castaing, Didier SamuelAbstract:BACKGROUND: Management of portal inflow to the graft in patients with spontaneous splenorenal shunts (SRS) is a matter of concern especially in case of large varices (more than 1 cm). In case of portal Vein (PV) thrombosis (PVT), renoportal anastomosis (RPA) directly diverts the splanchnic and renal venous blood assuring a good portal inflow to the graft. Disconnection of the portacaval shunt by left renal Vein Ligation (LRVL) is another option but requires a patent PV. The indication of primary RPA rather than LRVL in patients with small native PV, especially in case of large graft, should be questioned in these complex cases of liver transplantation. METHODS: From 1998 to 2012, 17 patients with RPA and 15 patients with LRVL were transplanted in our center. We compared these 2 techniques for short- and long-term results. RESULTS: The rate of preliver transplantation PVT (76% vs 27%) and graft weight (1538 ± 383 g vs 1293 ± 216 g) was significantly higher in the RPA group. Renoportal anastomosis was performed in 4 cases of small but patent PV. Three-month mortality, morbidity, and massive ascitis were similar. No patient was retransplanted. One year after transplantation, PV diameter was still larger in RPA group. Three-year survival was similar (RPA: 79% vs LRVL: 53%, P = 0.1). CONCLUSIONS: In cirrhotic patients transplanted with large splenorenal shunts, RPA and LRVL reach similar survivals. In case of complete PVT and failure of thrombectomy, the RPA offers satisfactory long-term results.
Victoria Ardiles - One of the best experts on this subject based on the ideXlab platform.
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survival after associating liver partition and portal Vein Ligation for staged hepatectomy alpps for advanced colorectal liver metastases a case matched comparison with palliative systemic therapy
Surgery, 2017Co-Authors: Pim B. Olthof, René Adam, Pierre-alain Clavien, Victoria Ardiles, Michael Linecker, Joost Huiskens, Dennis A Wicherts, Pablo E Huespe, Ricardo Roblescampos, Miriam KoopmanAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment. Methods All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival. Results Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and Conclusion Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
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survival after associating liver partition and portal Vein Ligation for staged hepatectomy alpps for advanced colorectal liver metastases a case matched comparison with palliative systemic therapy
Surgery, 2017Co-Authors: Pim B. Olthof, René Adam, Pierre-alain Clavien, Victoria Ardiles, Michael Linecker, Joost Huiskens, Dennis A Wicherts, Pablo E Huespe, Ricardo Roblescampos, Miriam KoopmanAbstract:Background Associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment. Methods All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival. Results Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and P = .002). Median disease-free survival was 6 months compared to 12 months ( P P = .088). Conclusion Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
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associating liver partition and portal Vein Ligation for staged hepatectomy offers high oncological feasibility with adequate patient safety a prospective study at a single center
Annals of Surgery, 2015Co-Authors: Fernando A Alvarez, Victoria Ardiles, Juan Pekolj, Martin De Santibanes, Eduardo De SantibanesAbstract:Objective:To determine the safety, feasibility, and efficacy of associating liver partition and portal Vein Ligation for staged hepatectomy (ALPPS) in a single high-volume hepatobiliary center.Background:The ALPPS approach allows achieving resectability of liver malignancies by a rapid and large fut
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alpps offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional staged hepatectomies results of a multicenter analysis
World Journal of Surgery, 2014Co-Authors: Erik Schadde, Victoria Ardiles, Christoph Tschuor, Roberto Hernandezalejandro, Ksenija Slankamenac, Gregory Sergeant, Nadja Amacker, J Baumgart, Kris P Croome, H LangAbstract:Background Portal Vein occlusion to increase the size of the future liver remnant (FLR) is well established, using portal Vein Ligation (PVL) or embolization (PVE) followed by resection 4–8 weeks later. Associating liver partition with portal Vein Ligation for staged hepatectomy (ALPPS) combines PVL and complete parenchymal transection, followed by hepatectomy within 1–2 weeks. ALPPS has been recently introduced but remains controversial. We compare the ability of ALPPS versus PVE or PVL for complete tumor resection.
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associating liver partition and portal Vein Ligation for staged hepatectomy alpps tips and tricks
Journal of Gastrointestinal Surgery, 2013Co-Authors: Fernando A Alvarez, Victoria Ardiles, Rodrigo Sanchez Claria, Juan Pekolj, Eduardo De SantibanesAbstract:Background Posthepatectomy liver failure is the most severe complication after major hepatectomies and it is associated with an insufficient future liver remnant (FLR). Associating liver partition and portal Vein Ligation (PVL) has recently been described as a revolutionary strategy to induce a rapid and large FLR volume increase. We aim to describe our surgical technique, patient management, and preliminary results with this new two-stage approach.
