Background

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has expanded and spearheaded development in hepatobiliary surgery. Monosegment-ALPPS tests liver regeneration limits and may present as the last feasible curative treatment option.

Methods

Electronic databases (MEDLINE, Web of Science, Google Scholar, Cochrane Library and WHO International Clinical Trials Registry Platform) were searched for publications on mono-ALPPS using a predefined strategy without date or language restrictions. Individual patient data was extracted and analyzed.

Results

237 publications were identified. 19 patients were identified to have undergone mono-ALPPS. Primarily, mono-ALPPS has been utilized as curative treatment for CRLM (17 of 19 cases). Successful mono-ALPPS was possible in FLR above 8% SLV. All patients received either chemotherapy alone or in combination with radiotherapy prior to surgery. 8 of 19 patients experienced PHLF grade A or B. There was no in-hospital mortality described. Recurrent disease has occurred in 7 of 19 patients and 3 have died during follow-up.

Conclusion

Mono-ALPPS is an experimental procedure that provides a reasonably safe opportunity to curatively treat extensive liver malignancies in patients with FLR as low as 8% SLV. PHLF is the most prevalent complication in mono-ALPPS. Mono-ALPPS should be evaluated in a multicentral study setting.

中文翻译：

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推动肝再生的极限——单节段后的安全性和生存期-ALPPS：系统评价和个体患者数据荟萃分析

背景

分期肝切除术 (ALPPS) 将肝分割和门静脉结扎相结合已经扩大并引领了肝胆外科的发展。Monosegment-ALPPS 测试肝再生极限，并可能作为最后可行的治愈性治疗选择。

方法

使用没有日期或语言限制的预定义策略搜索电子数据库（MEDLINE、Web of Science、Google Scholar、Cochrane Library 和 WHO 国际临床试验注册平台）以查找关于单 ALPPS 的出版物。提取和分析个体患者数据。

结果

确定了 237 份出版物。19 名患者被确定接受了单 ALPPS。首先，单 ALPPS 已被用作 CRLM 的治愈性治疗（19 例中的 17 例）。在 FLR 高于 8% SLV 时，成功的单 ALPPS 是可能的。所有患者在手术前接受单独化疗或联合放疗。19 名患者中有 8 名经历了 PHLF A 或 B 级。没有描述住院死亡率。19 例患者中有 7 例出现复发性疾病，3 例在随访期间死亡。

结论

Mono-ALPPS 是一种实验性程序，可为 FLR 低至 8% SLV 的患者提供相当安全的机会来治愈广泛的肝脏恶性肿瘤。PHLF 是单 ALPPS 中最常见的并发症。Mono-ALPPS 应在多中心研究环境中进行评估。