Système gastro-intestinal et digestif

Abstrait

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy: A Contemporary Surgical Oncology Conundrum

Peteja M, Pelikan A, Vavra P, Lerch M, Ihnat P, Zonca P, Janout V

Aim: The aim of this paper is ongoing evaluation of the Associating Partition Liver and Portal Vein Ligation for Staged Hepatectomy (ALPPS) and present changes in the perception of the use of this method. This paper also includes the case history of the first patient who underwent the operation at the authors' department.

Material and method: A systematic literature review: PubMed database for keywords ALPPS or stage liver resection. The primary aim of the study was to evaluate the potential of this method leading to hypertrophy of liver tissue. Secondary aims included the analysis of morbidity and mortality and the evaluation of technical aspects.

Results: After entering the keywords into the PubMed database, having regard to the inclusion and exclusion criteria, several cohort studies were identified. No prospective randomized study was found. By analysing the results of individual papers we found that hypertrophy of the liver parenchyma ranged from 61% to 93%. Morbidity of the published populations ranged from 9% to 71%, with mortality from 0% to 13%.

Conclusion: Given the high morbidity and mortality, ALPPS is the most discussed modality in hepatobiliary surgery as well as in general surgery. Despite the not-so-flattering results achieved so far, the authors believe that this method has its place in the hepatobiliary surgery to treat liver tumours. However, long-term results are not yet available.