Hepato-bilio-pancreatic and Liver Transplant Unit, Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy.
Division of Gastroenterology, Department of Clinical Medicine, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy.
J Gastrointest Surg. 2019 Sep;23(9):1917-1924. doi: 10.1007/s11605-018-04092-x. Epub 2019 Jun 13.
Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) represents a new surgical technique for the resection of advanced hepatic malignancies with predicted insufficient future liver remnant. In some patients, ALPPS can be associated with an increased risk of poor outcomes. Minimally invasive surgery (MIS) has been proposed in combination with ALPPS with the intent to minimize this risk. We systematically evaluated the outcomes of MIS-ALPPS cases to compare the relative outcomes of open ALPPS versus MIS-ALPPS.
A systematic review was done in accordance with the PRISMA guidelines. Search terms utilized included the following: ("ALPPS"[Title/Abstract] OR "associating liver partition and portal vein ligation for staged hepatectomy"[Title/Abstract] OR "in situ split"[Title/Abstract]) AND ("minimally invasive"[Title/Abstract] OR "laparoscopic"[Title/Abstract] OR "robotic"[Title/Abstract]).
Fifteen articles were identified, with a total of 27 patients reported. Colorectal metastatic disease was the most commonly observed indication for MIS-ALPPS (66.7%), followed by hepatocellular carcinoma (25.9%). Time passed from the first to the second stage ranged 7-30 days. MIS-ALPPS patients did not experience procedure failures between the first and second stages. Only four (15.4%) subjects had a grade IIIb complication. No perioperative mortality after the first or second stage was reported. Compared with open ALPPS, MIS-ALPPS demonstrated better results. Hospital stay duration ranged 8-33 days with a follow-up ranging 1-20 months.
MIS-ALPPS appears to be safe, with potentially lower morbidities and mortalities relative to open patients. The present results should be considered with caution. A limited number of articles exist on this topic. Furthermore, selection biases exist when comparing open versus MIS-ALPPS data. Registry studies are needed to better define the outcomes of patients undergoing MIS-ALPPS.
联合肝脏离断和门静脉结扎的分阶段肝切除术（ALPPS）代表了一种新的手术技术，用于治疗预计未来剩余肝脏不足的晚期肝恶性肿瘤。在某些患者中，ALPPS 可能会增加不良结局的风险。微创外科（MIS）已被提议与 ALPPS 联合应用，目的是降低这种风险。我们系统地评估了 MIS-ALPPS 病例的结果，以比较开放 ALPPS 与 MIS-ALPPS 的相对结果。
根据 PRISMA 指南进行系统评价。使用的搜索词包括以下内容：（“ALPPS”[标题/摘要]或“联合肝脏离断和门静脉结扎的分阶段肝切除术”[标题/摘要]或“原位分裂”[标题/摘要]）和（“微创”[标题/摘要]或“腹腔镜”[标题/摘要]或“机器人”[标题/摘要]）。
共确定了 15 篇文章，其中报道了 27 例患者。MIS-ALPPS 的最常见适应证是结直肠转移性疾病（66.7%），其次是肝细胞癌（25.9%）。从第一阶段到第二阶段的时间间隔为 7-30 天。MIS-ALPPS 患者在第一阶段和第二阶段之间没有发生手术失败。只有 4 例（15.4%）患者出现 3b 级并发症。第一阶段或第二阶段后均无围手术期死亡报告。与开放 ALPPS 相比，MIS-ALPPS 显示出更好的结果。住院时间为 8-33 天，随访时间为 1-20 个月。
MIS-ALPPS 似乎是安全的，与开放患者相比，其发病率和死亡率可能较低。目前的结果应谨慎考虑。关于这个主题的文章数量有限。此外，在比较开放与 MIS-ALPPS 数据时存在选择偏倚。需要注册研究来更好地定义接受 MIS-ALPPS 治疗的患者的结果。
