Baili Efstratia, Tsilimigras Diamantis, Filippou Dimitrios, Ioannidis Agis, Bakopoulos Anargyros, Machairas Nikolaos, Papalampros Alexandros, Petrou Athanasios, Schizas Dimitrios, Moris Demetrios
First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
J BUON. 2019 Jul-Aug;24(4):1371-1381.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) represents a revolutionary new surgical technique and one of the most promising advances in liver surgery over the last decade, which provides rapid and effective growth of liver remnant volume, allowing surgical resection of hepatic lesions initially considered unresectable. The aim of this review was to address from a critical point of view, the impact of this novel procedure conducted for primary liver malignancies, on tumor biology itself and thus on short and long-term outcomes, as disease free survival and overall survival.
The present study was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Identification of eligible studies was performed through a systematic search of the literature using Medline/PubMed, Scopus, Cochrane, Google Scholar, and clinicaltrials.gov databases. The end date of the literature search was set to 30th November 2018. The following keywords were used for the search: "Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy", "ALPPS", "Portal Vein Embolization (PVE) And In Situ Split", "Portal Vein Ligation (PVL) And In Situ Split".
The 28 studies enrolled in the present analysis incorporated 136 patients who were subjected to ALPPS due to primary liver malignancy. R0 resection status has been documented in 20 studies estimated to be 97.24%. 30-day mortality was 9.55%. Concerning 30-day morbidity graded according to Clavien-Dindo classification, interestingly 7 studies stated no postoperative complications, neither minor (I-II) nor major (III-V). As for the oncological outcomes, median follow up was 10 months (range 0-36), recurrence rate was 36%, disease free survival ranged from 1 to 36 months with a median of 6 months and overall survival ranged from 1 to 36 months with a median of 11 months.
ALPPS offers a reasonable chance of complete resection in patients with unresectable primary liver tumors. Optimal selection of patients, gaining the surgical experience of carrying out this technique and its impact on short and long-term results are issues that still remain under debate while waiting for the final outcomes of the multicenter registries with larger number of cases.
联合肝脏分隔与门静脉结扎分期肝切除术（ALPPS）是一种革命性的新手术技术，也是过去十年肝脏手术中最有前景的进展之一，它能使肝残余体积快速有效增长，从而能够对最初认为不可切除的肝脏病变进行手术切除。本综述旨在从批判性的角度探讨这一针对原发性肝癌的新手术方法对肿瘤生物学本身以及短期和长期预后（如无病生存期和总生存期）的影响。
本研究按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行设计。通过使用Medline/PubMed、Scopus、Cochrane、谷歌学术和clinicaltrials.gov数据库对文献进行系统检索来确定符合条件的研究。文献检索截止日期设定为2018年11月30日。检索使用了以下关键词：“联合肝脏分隔与门静脉结扎分期肝切除术”、“ALPPS”、“门静脉栓塞（PVE）与原位劈离”、“门静脉结扎（PVL）与原位劈离”。
纳入本分析的28项研究共包含136例因原发性肝癌接受ALPPS的患者。20项研究记录了R0切除状态，估计为97.24%。30天死亡率为9.55%。关于根据Clavien-Dindo分类分级的30天发病率，有趣的是，7项研究表明无术后并发症，无论是轻微（I-II级）还是严重（III-V级）。至于肿瘤学结局，中位随访时间为10个月（范围0-36个月），复发率为36%，无病生存期为1至36个月，中位值为6个月，总生存期为1至36个月，中位值为11个月。
ALPPS为不可切除的原发性肝癌患者提供了合理的完全切除机会。患者的最佳选择、积累实施该技术的手术经验及其对短期和长期结果的影响，在等待更多病例的多中心登记研究的最终结果时，仍是有待讨论的问题。
