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Langenbeck's Archives of Surgery
Erschienen in: Langenbeck's Archives of Surgery 4/2017

10.05.2017 | REVIEW ARTICLE

Modified ALPPS procedures: more safety through less invasive surgery

verfasst von: Kuniya Tanaka

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 4/2017

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Abstract

Purpose

Although associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been advocated for treating advanced liver tumors, increased morbidity and mortality remain serious problems. Many modified procedures have been devised to improve patient safety, but some confusion persists as to benefits and risks.

Methods

Modifications to ALPPS as originally reported were reviewed to clarify their contributions to safety and their clinical relevance.

Results

A variety of modifications are explained and considered. Modifications mainly aim to reduce adhesions, prevent tumor spread, avoid devascularization during liver splitting, and reduce surgical severity. Such changes aiming to increase safety and reduce invasiveness are needed to avoid high morbidity and mortality rates with this innovative procedure. However, these modified procedures still require more meaningful statistical comparisons of outcome.

Conclusions

Prospective controlled studies are needed to confirm which modified procedures should be adopted in a standardized manner as an alternative to the original ALPPS. Further, we need to further explore mechanisms of liver regeneration, functional recovery, histopathologic changes of hepatocytes, and blood distribution during ALPPS simultaneously to developing and evaluating modifications of the procedure.
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Metadaten
Titel
Modified ALPPS procedures: more safety through less invasive surgery
verfasst von
Kuniya Tanaka
Publikationsdatum
10.05.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 4/2017
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-017-1588-3

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