Abstract
BackgroundALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a novel two-stage strategy to induce rapid hypertrophy of the future liver remnant (FLR) when patients are in danger of postoperative liver failure due to insufficient FLR. However, the effects of ALPPS on colorectal liver metastases (CRLM) are not clear so far. The aim of our study was to determine whether ALPPS induces proliferation, apoptosis, or vascularization compared to standard (one-stage) liver resection.MethodsSix patients who underwent ALPPS were matched with 12 patients undergoing standard liver resection regarding characteristics of the metastases (size, number), time of appearance (syn-/metachronous), preoperative chemotherapy, primary tumor (localization, TNM stage, grading), and patient variables (gender, age). The largest resected metastasis was used for the analyses. Tissue was stained for tumor cell proliferation (Ki67), apoptosis (TUNEL, caspase-3), vascularization (CD31), and pericytes (αSMA).ResultsVascularization (CD31; p = 0.149), proliferation (Mib-1; p = 0.244), and αSMA expression (p = 0.205) did not significantly differ between the two groups, although a trend towards less proliferation and αSMA expression was observed in patients undergoing ALPPS. Concerning apoptosis, caspase-3 staining showed significantly fewer apoptotic cells upon ALPPS (p < 0.0001), but this was not confirmed by TUNEL staining (p = 0.7344).ConclusionsALPPS does not induce proliferation, apoptosis, or vascularization of CRLM when compared to standard liver resection.
Highlights
ALPPS is a novel twostage strategy to induce rapid hypertrophy of the future liver remnant (FLR) when patients are in danger of postoperative liver failure due to insufficient FLR
We have recently introduced a novel two-stage approach for rapid hypertrophy of the FLR in extended right hepatectomy by combining a complete transection of the liver along the falciforme ligament with dissection of the right portal vein, known as ALPPS or “in situ split liver resection” (ISS) [17]
The present study provides evidence that ALPPS is not associated with parameters characteristic of increased tumor growth at the time point of final resection of metastases
Summary
ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a novel twostage strategy to induce rapid hypertrophy of the future liver remnant (FLR) when patients are in danger of postoperative liver failure due to insufficient FLR. The effects of ALPPS on colorectal liver metastases (CRLM) are not clear so far. Approximately 20–25% of well-perfused normal tissue is regarded to be sufficient to maintain the postoperative liver function in otherwise healthy livers [8, 9]. Another option to calculate the needed FLR is to refer the volume of the FLR to the body weight (BW). A FLR/BW ratio of more than 0.5 is suggested to be enough to prevent posthepatectomy liver failure (PHLF) [10]
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