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World J Gastroenterol. Oct 21, 2013; 19(39): 6548-6554
Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6548
Current position of ALPPS in the surgical landscape of CRLM treatment proposals
Marcello Donati, Gregor A Stavrou, Karl J Oldhafer
Marcello Donati, Gregor A Stavrou, Karl J Oldhafer, Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, 22291 Hamburg, Germany
Marcello Donati, Department of Surgery, General and Oncologic Surgery Unit, Vittorio-Emanuele University Hospital of Catania, 95122 Catania, Italy
Author contributions: Donati M and Oldhafer KJ equally contributed to the present work; Donati M wrote the article; Donati M and Oldhafer KJ collaborated on design and conception; Donati M and Stavrou GA completed literature research, data collection and wrote the table; Stavrou GA made the first language and style revision; Donati M and Oldhafer KJ made the final critical review of article.
Correspondence to: Marcello Donati, MD, PhD, Assistant Professor, Department of Surgery. General and Oncologic Surgery Unit, Vittorio-Emanuele University Hospital,Via Plebiscito 628, 95122 Catania, Italy. mdonati@unict.it
Telephone: +39-95-7435117 Fax: +39-95-7435117
Received: April 12, 2013
Revised: July 21, 2013
Accepted: August 17, 2013
Published online: October 21, 2013
Processing time: 210 Days and 21.4 Hours
Abstract

The Authors summarize problems, criticisms but also advantages and indications regarding the recent surgical proposal of associating liver partition and portal vein ligation (PVL) for staged hepatectomy (ALPPS) for the surgical management of colorectal liver metastases. Looking at published data, the technique, when compared with other traditional and well established methods such as PVL/portal vein embolisation (PVE), seems to give real advantages in terms of volumetric gain of future liver remnant. However, major concerns are raised in the literature and some questions remain unanswered, preliminary experiences seem to be promising. The method has been adopted all over the world over the last 2 years, even if oncological long-term results remain unknown, and benefit for patients is questionable. No prospective studies comparing traditional methods (PVE, PVL or classical 2 staged hepatectomy) with ALPPS are available to date. Technical reinterpretations of the original method were also proposed in order to enhance feasability and increase safety of the technique. More data about morbidity and mortality are also expected. The real role of ALPPS is, to date, still to be established. Large clinical studies, even if, for ethical reasons, in well selected cohorts of patients, are expected to better define the indications for this new surgical strategy.

Keywords: Portal ligation; In situ split; Liver resections; Colorectal metastases; Liver metastases

Core tip: The recent publication by Regensburg’s Group on the new technical possibility of associating liver partition and portal vein ligation for staged hepatectomy for the surgical managing of bilateral colorectal liver metastases, generated a great debate and a burst of publications about preliminary experiences from many groups all over the world. As one of the first groups in Germany to adopt this technique, in the present article we clarify some aspects of our experience in the light of published data and raised concerns.