Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, 01308-050, Brazil.
Cancer Institute of the State of São Paulo and Department of Radiology and Oncology, Medical School, University of São Paulo , São Paulo, Brazil.
Abdom Radiol (NY). 2016 Nov;41(11):2150-2160. doi: 10.1007/s00261-016-0832-6.
Hepatic resection is the only potentially curative treatment for patients with colorectal liver metastasis (CRLM). Many multidisciplinary approaches, including the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure, have been proposed to increase the resectability rate in these patients. ALPPS is the most recently described staged liver resection technique, representing an advantageous strategy to induce a rapid and marked increase in the future liver remnant (FLR) volume. The aim of this article is to describe the radiological evaluation of this procedure and its variation.
This retrospective study included 9 patients with CRLM who underwent the ALPPS procedure. Abdominal imaging studies were reviewed, with an emphasis on a rational radiological approach. The number of liver metastases, the FLR volume (pre- and postportal vein ligation), anatomical variations, potential pitfalls related to disease progression, and postoperative complications were evaluated.
The types of hepatic resection included 4 classical ALPPS cases, 3 right ALPPS variations, and 2 left ALPPS variations. The mean FLR volume calculated in the initial evaluation was 453 mL (213-790 mL). Following the first surgery, the mean FLR volume increased to 634 mL (410-957 mL), which indicated a mean volume increase of 181.1 mL (95% CI 149.7-212.5 mL; p < 0.001) and a mean absolute volume increase of 48% (19%-88%).
The ALPPS procedure is an emerging form of two-stage hepatectomy. In this context, radiologists should provide crucial preoperative and perioperative information that may change surgical planning and contribute to an improvement in the oncologic outcome.
肝切除术是结直肠癌肝转移（CRLM）患者唯一可能治愈的治疗方法。为提高这些患者的可切除性，提出了许多多学科方法，包括联合肝脏分隔和门静脉结扎的分期肝切除术（ALPPS）。ALPPS 是最近描述的分期肝切除技术，代表了一种有利的策略，可以快速、显著增加未来肝脏残余（FLR）体积。本文旨在描述该手术的影像学评估及其变化。
本回顾性研究纳入了 9 例接受 ALPPS 手术的 CRLM 患者。回顾了腹部影像学研究，重点是合理的影像学方法。评估了肝转移的数量、FLR 体积（门静脉结扎前后）、解剖变异、与疾病进展相关的潜在陷阱以及术后并发症。
肝切除术的类型包括 4 例经典 ALPPS 病例、3 例右 ALPPS 变异和 2 例左 ALPPS 变异。初始评估时计算的平均 FLR 体积为 453ml（213-790ml）。第一次手术后，平均 FLR 体积增加到 634ml（410-957ml），表明平均体积增加 181.1ml（95%CI 149.7-212.5ml;p<0.001），绝对体积增加 48%（19%-88%）。
ALPPS 手术是一种新兴的两阶段肝切除术。在这种情况下，放射科医生应提供关键的术前和围手术期信息，这些信息可能会改变手术计划，并有助于改善肿瘤学结果。
