Advances in clinical and basic research of associating liver partition and portal vein ligation for staged hepatectomy
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1.Department of Hepatic Oncology & Liver Transplantation, Zhongshan Hospital Affiliated to Fudan University;2.Fudan University Liver Cancer Institute, Shanghai 200032, China

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R735.7

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    Abstract:

    The Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), first developed by Professor Hans Schlitt from Germany in 2007, combines the ligation of the portal vein branches of the tumor-bearing lobe and separation of the tumor-bearing lobe from the healthy lobe at the same time during the first stage, allows for rapid regeneration of the healthy lobe within 1-2 weeks. Once the healthy liver lobe has grown sufficiently, the tumor-bearing lobe is removed in the second stage of operation, which provides an opportunity for radical resection for a significant portion of patients with liver cancer initially considered unresectable. ALPPS has remarkable efficacy inducing more rapid liver regeneration than traditional portal vein embolization. Furthermore, with the accumulation of surgical experience and refinements in surgical techniques, the postoperative complication rate of ALPPS has significantly decreased. As a result, it is increasingly being applied in the treatment of primary and secondary liver tumors, including colorectal liver metastases, hepatocellular carcinoma, and intrahepatic cholangiocarcinoma. Since its inception, ALPPS has undergone continuous clinical modifications, such as advancements in basic surgical techniques and skills, minimally invasive hepatic partition, minimally invasive portal vein ligation, minimally invasive surgical approaches, and rescue ALPPS using transcatheter arterial embolization. During the liver regeneration induced by ALPPS, significant changes can occur in the hepatic immune microenvironment. However, the roles of key immune components, spatial origin, distribution, and subpopulation characteristics during liver regeneration remain to be clarified. The specific effects and mechanisms of ALPPS on liver tumors are not fully understood and require further exploration and confirmation. The clinical application prospects of ALPPS are promising, and research on related mechanisms may offer new insights into the active induction of liver regeneration and the prevention and treatment of liver function failure.

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YAN Jiayan, YANG Xinrong, ZHOU Jian. Advances in clinical and basic research of associating liver partition and portal vein ligation for staged hepatectomy[J]. Chin J Gen Surg,2023,32(7):967-976.
DOI:10.7659/j. issn.1005-6947.2023.07.001

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History
  • Received:June 12,2023
  • Revised:July 09,2023
  • Adopted:
  • Online: November 03,2023
  • Published: