Associating liver partition and portal vein ligation for staged hepatectomy in Qatar: Initial experience with two case series and review of the literature
| Autor: | Ahmed Mahfouz, Walid Elmoghazy, Hatem Khalaf, Ibnouf Sulieman, Mohammed Said Ghali, A. Elaffandi |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
ALT alanine transaminase medicine.medical_treatment FLR future liver remnant Portal vein ligation 030230 surgery Liver resections Article Resection 03 medical and health sciences 0302 clinical medicine ALPPS associating liver partition and portal vein ligation for staged hepatectomy AST aspartate transaminase IVC inferior vena cava medicine PVL portal vein ligation Embolization Stage (cooking) RFA radiofrequency ablation PVE portal vein embolizainferior vena cavation Abdominal wall tumor RALPP radiofrequency assisted liver partition business.industry medicine.disease Associating liver partition and portal vein ligation for staged hepatectomy Surgery CT computed tomography Liver 030220 oncology & carcinogenesis SPECT single photon emission computed tomography ALTPS associating liver tourniquet and portal vein occlusion for staged hepatectomy Sarcoma ALPPS Hepatectomy business FDG-PET fluorodeoxyglucose positron emission tomography MRI magnetic resonance imaging CUSA cavitron ultrasonic surgical aspirator |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • The volume of the liver that can be resected is limited by the need to leave behind liver tissue of sufficient volume to carry our normal liver functions and allow regeneration. • Two staged hepatectomy and portal vein embolization/ligation allow hypertrophy of the future liver remnant, but the long period required may allow tumor progression. • ALPPS combines portal vein ligation with transection of the liver tissue, inducing rapid hypertrophy of the future remnant liver. • Despite high morbidity and mortality initially, the procedure is now safe due to better technique and the selection criteria. • Future efforts are directed towards better evaluation of liver function, refinements in the technique, and more accurate patient selection. Introduction Associating Liver Partition and Portal Vein Ligation for Staged -hepatectomy (ALPPS) is an evolving procedure that allows rapid hypertrophy of the future liver remnant (FLR). We describe the first two cases performed in Qatar. Case presentations Case 1: A 53 -year old male with sarcoma metastases to the liver 8 years after resection of an abdominal wall tumor, requiring an extended right hepatectomy but with in an inadequate FLR. ALPPS was done and he achieved 147% increase in the volume of the FLR within 6 days (from 15.9%–34.2%). The second stage was completed successfully on day 7. Case 2: A 59-year old male patient had colorectal liver metastases that required an extended right liver resection and had inadequate FLR of 19.8%. Seven days after the first stage, the FLR hypertrophied to 37.7% (90.2% increase in volume) and the second stage was completed successfully on day 8. Both patients had uneventful recovery and no recurrence or complications on follow up. Discussion ALPPS allows large liver resections while circumventing the long delay in the conventional two staged hepatectomy and portal vein ligation/embolization. The reported morbidity and mortality in earlier series was high, but recent selection criteria and technique refinements reduce this morbidity. Many variations are still being reported. Conclusion ALPPS is an evolving technique that adds to the armamentarium of the liver surgeon to allow larger liver resections in a timely manner. It is feasible and safe to be performed with careful selection. |
| Databáze: | OpenAIRE |
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