Total Laparoscopic Reversal ALPPS

Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows R0 resection even for patients with extremely small future liver remnants. The ALPPS procedure was initially described for two-stage right trisectionectomy. Reversal ALPPS is a denomination in which...

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Veröffentlicht in:Annals of surgical oncology 2017-04, Vol.24 (4), p.1048-1049
Hauptverfasser: Machado, M. A., Surjan, R., Basseres, T., Makdissi, F.
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container_issue 4
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container_title Annals of surgical oncology
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creator Machado, M. A.
Surjan, R.
Basseres, T.
Makdissi, F.
description Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows R0 resection even for patients with extremely small future liver remnants. The ALPPS procedure was initially described for two-stage right trisectionectomy. Reversal ALPPS is a denomination in which the future liver remnant is the right posterior section of the liver. Patient A 42-year-old woman with colorectal metastases in all segments except segment 1 underwent chemotherapy with objective response and was referred for surgical treatment. The computed tomography (CT) scan showed a predominance of metastases in the left liver and in the right anterior section. The right posterior section had three metastases. The plan was to perform a laparoscopic reversal ALPPS (left portal vein ligation combined with in situ splitting in a two-stage left trisectionectomy). Technique Three metastases in the right posterior section were resected, followed by liver partition and left portal vein ligature. The CT scan showed a 70 % increase in the future liver remnant. The second stage constituted left trisectionectomy. At laparoscopy after division of adhesions, the left Glissonian pedicle was divided with an endostapler. A stapler also was used to transect the left and middle hepatic veins, and the specimen was removed through a suprapubic incision. The operative times were respectively 5 and 3 h, and the patient was discharged on days 4 and 5, respectively. No blood transfusion or intensive care unit stay was necessary. At this writing, the patient shows no evidence of the disease 18 months after the procedure. Conclusions Reversal laparoscopic ALPPS is feasible and safe. Laparoscopy is useful for decreasing blood loss and optimizing visualization during liver transection.
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A. ; Surjan, R. ; Basseres, T. ; Makdissi, F.</creator><creatorcontrib>Machado, M. A. ; Surjan, R. ; Basseres, T. ; Makdissi, F.</creatorcontrib><description>Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows R0 resection even for patients with extremely small future liver remnants. The ALPPS procedure was initially described for two-stage right trisectionectomy. Reversal ALPPS is a denomination in which the future liver remnant is the right posterior section of the liver. Patient A 42-year-old woman with colorectal metastases in all segments except segment 1 underwent chemotherapy with objective response and was referred for surgical treatment. The computed tomography (CT) scan showed a predominance of metastases in the left liver and in the right anterior section. The right posterior section had three metastases. The plan was to perform a laparoscopic reversal ALPPS (left portal vein ligation combined with in situ splitting in a two-stage left trisectionectomy). Technique Three metastases in the right posterior section were resected, followed by liver partition and left portal vein ligature. The CT scan showed a 70 % increase in the future liver remnant. The second stage constituted left trisectionectomy. At laparoscopy after division of adhesions, the left Glissonian pedicle was divided with an endostapler. A stapler also was used to transect the left and middle hepatic veins, and the specimen was removed through a suprapubic incision. The operative times were respectively 5 and 3 h, and the patient was discharged on days 4 and 5, respectively. No blood transfusion or intensive care unit stay was necessary. At this writing, the patient shows no evidence of the disease 18 months after the procedure. Conclusions Reversal laparoscopic ALPPS is feasible and safe. Laparoscopy is useful for decreasing blood loss and optimizing visualization during liver transection.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-016-5620-6</identifier><identifier>PMID: 27734177</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Colorectal Neoplasms - pathology ; Female ; Hepatectomy - methods ; Hepatobiliary Tumors ; Humans ; Laparoscopy ; Ligation ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Medicine ; Medicine &amp; Public Health ; Oncology ; Portal Vein - surgery ; Surgery ; Surgical Oncology</subject><ispartof>Annals of surgical oncology, 2017-04, Vol.24 (4), p.1048-1049</ispartof><rights>Society of Surgical Oncology 2016</rights><rights>Annals of Surgical Oncology is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-1a0417fa4b7d214b11eeea36b0716f7285648ce9e76e71f7b04ea7c1f1e96b923</citedby><cites>FETCH-LOGICAL-c372t-1a0417fa4b7d214b11eeea36b0716f7285648ce9e76e71f7b04ea7c1f1e96b923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-016-5620-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-016-5620-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27734177$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Machado, M. A.</creatorcontrib><creatorcontrib>Surjan, R.</creatorcontrib><creatorcontrib>Basseres, T.</creatorcontrib><creatorcontrib>Makdissi, F.</creatorcontrib><title>Total Laparoscopic Reversal ALPPS</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows R0 resection even for patients with extremely small future liver remnants. The ALPPS procedure was initially described for two-stage right trisectionectomy. Reversal ALPPS is a denomination in which the future liver remnant is the right posterior section of the liver. Patient A 42-year-old woman with colorectal metastases in all segments except segment 1 underwent chemotherapy with objective response and was referred for surgical treatment. The computed tomography (CT) scan showed a predominance of metastases in the left liver and in the right anterior section. The right posterior section had three metastases. The plan was to perform a laparoscopic reversal ALPPS (left portal vein ligation combined with in situ splitting in a two-stage left trisectionectomy). Technique Three metastases in the right posterior section were resected, followed by liver partition and left portal vein ligature. The CT scan showed a 70 % increase in the future liver remnant. The second stage constituted left trisectionectomy. At laparoscopy after division of adhesions, the left Glissonian pedicle was divided with an endostapler. A stapler also was used to transect the left and middle hepatic veins, and the specimen was removed through a suprapubic incision. The operative times were respectively 5 and 3 h, and the patient was discharged on days 4 and 5, respectively. No blood transfusion or intensive care unit stay was necessary. At this writing, the patient shows no evidence of the disease 18 months after the procedure. Conclusions Reversal laparoscopic ALPPS is feasible and safe. Laparoscopy is useful for decreasing blood loss and optimizing visualization during liver transection.</description><subject>Adult</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Female</subject><subject>Hepatectomy - methods</subject><subject>Hepatobiliary Tumors</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Ligation</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Oncology</subject><subject>Portal Vein - surgery</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1LAzEQhoMotlZ_gBepePGymsnn7rEUv2DBovUcsumstGy7a9IV_Pdm3SoieEqYPPNO5iHkFOgVMCGvA1DBRUJBJVIxmqg9MgQZK0KlsB_vVKVJxpQckKMQVpSC5lQekgHTmgvQekjO5_XWVuPcNtbXwdXN0o2f8B19iNVJPps9H5OD0lYBT3bniLzc3syn90n-ePcwneSJ45ptE7A0JpZWFHrBQBQAiGi5KqgGVWqWSiVShxlqhRpKXVCBVjsoATNVZIyPyGWf2_j6rcWwNetlcFhVdoN1GwykXAqIe3foxR90Vbd-E38XKS0US-GLgp5ycbPgsTSNX66t_zBATefP9P5M9Gc6f0bFnrNdcluscfHT8S0sAqwHQnzavKL_Nfrf1E87Xnds</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Machado, M. 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A. ; Surjan, R. ; Basseres, T. ; Makdissi, F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-1a0417fa4b7d214b11eeea36b0716f7285648ce9e76e71f7b04ea7c1f1e96b923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Female</topic><topic>Hepatectomy - methods</topic><topic>Hepatobiliary Tumors</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Ligation</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - surgery</topic><topic>Medicine</topic><topic>Medicine &amp; Public Health</topic><topic>Oncology</topic><topic>Portal Vein - surgery</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Machado, M. A.</creatorcontrib><creatorcontrib>Surjan, R.</creatorcontrib><creatorcontrib>Basseres, T.</creatorcontrib><creatorcontrib>Makdissi, F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Machado, M. A.</au><au>Surjan, R.</au><au>Basseres, T.</au><au>Makdissi, F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Total Laparoscopic Reversal ALPPS</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>24</volume><issue>4</issue><spage>1048</spage><epage>1049</epage><pages>1048-1049</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows R0 resection even for patients with extremely small future liver remnants. The ALPPS procedure was initially described for two-stage right trisectionectomy. Reversal ALPPS is a denomination in which the future liver remnant is the right posterior section of the liver. Patient A 42-year-old woman with colorectal metastases in all segments except segment 1 underwent chemotherapy with objective response and was referred for surgical treatment. The computed tomography (CT) scan showed a predominance of metastases in the left liver and in the right anterior section. The right posterior section had three metastases. The plan was to perform a laparoscopic reversal ALPPS (left portal vein ligation combined with in situ splitting in a two-stage left trisectionectomy). Technique Three metastases in the right posterior section were resected, followed by liver partition and left portal vein ligature. The CT scan showed a 70 % increase in the future liver remnant. The second stage constituted left trisectionectomy. At laparoscopy after division of adhesions, the left Glissonian pedicle was divided with an endostapler. A stapler also was used to transect the left and middle hepatic veins, and the specimen was removed through a suprapubic incision. The operative times were respectively 5 and 3 h, and the patient was discharged on days 4 and 5, respectively. No blood transfusion or intensive care unit stay was necessary. At this writing, the patient shows no evidence of the disease 18 months after the procedure. Conclusions Reversal laparoscopic ALPPS is feasible and safe. Laparoscopy is useful for decreasing blood loss and optimizing visualization during liver transection.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>27734177</pmid><doi>10.1245/s10434-016-5620-6</doi><tpages>2</tpages></addata></record>
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subjects Adult
Colorectal Neoplasms - pathology
Female
Hepatectomy - methods
Hepatobiliary Tumors
Humans
Laparoscopy
Ligation
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Medicine
Medicine & Public Health
Oncology
Portal Vein - surgery
Surgery
Surgical Oncology
title Total Laparoscopic Reversal ALPPS
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