The many faces of ALPPS: surgical indications and techniques among surgeons collaborating in the international registry
| Autor: | Erik Schadde, Kelly Vogt, Roberto Hernandez-Alejandro, Suzana Buac, Andreas A. Schnitzbauer |
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| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Treatment outcome Portal vein 030230 surgery 03 medical and health sciences 0302 clinical medicine Postoperative Complications Risk Factors medicine Hepatectomy Humans Registries Healthcare Disparities Practice Patterns Physicians' Ligation Surgeons Hepatology business.industry Portal Vein Patient Selection Liver Neoplasms Gastroenterology Liver failure Hypertrophy Organ Size Hepatic tumour Surgery Liver Regeneration Treatment Outcome Liver 030220 oncology & carcinogenesis Health Care Surveys Original Article business Complication Colorectal Neoplasms |
| Zdroj: | HPB : the official journal of the International Hepato Pancreato Biliary Association. 18(5) |
| ISSN: | 1477-2574 |
| Popis: | ALPPS was developed to induce accelerated future liver remnant (FLR) hypertrophy in order to increase hepatic tumour resectability and reduce the risk of post-operative liver failure. While early studies demonstrated concerning complication rates, others reported favourable results. This inconsistency may be due to variability in surgical indications and technique.A web-based survey was sent to surgeons participating in the International ALPPS Registry in September of 2014. Questions addressed surgeon demographics and training, surgical indications and technique, and clinical management approaches.Fifty six out of 85 surgeons from 78 centers responded (66%) and half (n = 30) had training in liver transplantation. Forty seven (84%) did not reserve ALPPS solely for colorectal liver metastases (CRLM) and 30 (54%) would perform ALPPS for an FLR over 30%. Neoadjuvant chemotherapy for CRLM was recommended by 37 (66%) respondents. Surgical approaches varied considerably, with 30% not preserving outflow to the middle hepatic vein and 39% believing it necessary to skeletonize the hepatoduodenal ligament. Twenty five (45%) surgeons have observed segment 4 necrosis.There is considerable variability in how ALPPS is performed internationally. This heterogeneity in practice patterns may explain the current incongruity in published outcomes, and highlights the need for standardization. |
| Databáze: | OpenAIRE |
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