ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) does not affect proliferation, apoptosis, or angiogenesis as compared ... View Full Text


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Article Info

DATE

2017-03-07

AUTHORS

Katharina Joechle, Christian Moser, Petra Ruemmele, Katharina M. Schmidt, Jens M. Werner, Edward K. Geissler, Hans J. Schlitt, Sven A. Lang

ABSTRACT

BACKGROUND: ALPPS (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. METHODS: Six 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). RESULTS: Vascularization (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). CONCLUSIONS: ALPPS does not induce proliferation, apoptosis, or vascularization of CRLM when compared to standard liver resection. More... »

PAGES

57

References to SciGraph publications

  • 2013-02-06. Increased growth of colorectal liver metastasis following partial hepatectomy in CLINICAL & EXPERIMENTAL METASTASIS
  • 2014-04-19. ALPPS Offers a Better Chance of Complete Resection in Patients with Primarily Unresectable Liver Tumors Compared with Conventional-Staged Hepatectomies: Results of a Multicenter Analysis in WORLD JOURNAL OF SURGERY
  • 2015-06-08. Staged resection of bilobar colorectal liver metastases: surgical strategies in LANGENBECK'S ARCHIVES OF SURGERY
  • 2012-12-05. One-Stage Hepatectomy Following Portal Vein Embolization for Colorectal Liver Metastasis in WORLD JOURNAL OF SURGERY
  • 2013-12-11. ALPPS for Patients with Colorectal Liver Metastases: Effective Liver Hypertrophy, but Early Tumor Recurrence in WORLD JOURNAL OF SURGERY
  • 2014-11-04. Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma in BMC CANCER
  • 2015-02-18. Long-term results after in-situ split (ISS) liver resection in LANGENBECK'S ARCHIVES OF SURGERY
  • 2009-02-10. Effect of portal vein embolisation on the growth rate of colorectal liver metastases in BRITISH JOURNAL OF CANCER
  • 2006-09-06. Improving Resectability of Hepatic Colorectal Metastases: Expert Consensus Statement in ANNALS OF SURGICAL ONCOLOGY
  • 2016-06-08. Oncological Outcomes of Major Liver Resection Following Portal Vein Embolization: A Systematic Review and Meta-analysis in ANNALS OF SURGICAL ONCOLOGY
  • 2008-12-03. Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem? in ANNALS OF SURGICAL ONCOLOGY
  • 2014-03-17. Long-term Survival of Patients with Cholangiolocellular Carcinoma After Curative Hepatectomy in ANNALS OF SURGICAL ONCOLOGY
  • 2014-05-27. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): an analysis of tumor activity in UPDATES IN SURGERY
  • 2005-12-01. Treatment for multiple bilobar liver metastases of colorectal cancer in LANGENBECK'S ARCHIVES OF SURGERY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/s12957-017-1121-8

    DOI

    http://dx.doi.org/10.1186/s12957-017-1121-8

    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/28270160


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    40 schema:description BACKGROUND: ALPPS (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. METHODS: Six 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). RESULTS: Vascularization (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). CONCLUSIONS: ALPPS does not induce proliferation, apoptosis, or vascularization of CRLM when compared to standard liver resection.
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    58 characteristics
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    60 colorectal liver metastases
    61 danger
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    63 effects of ALPPS
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    67 group
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    70 largest resected metastasis
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    72 liver failure
    73 liver metastases
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    75 liver resection
    76 metastasis
    77 patient variables
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    79 pericytes
    80 postoperative liver failure
    81 preoperative chemotherapy
    82 primary tumor
    83 proliferation
    84 rapid hypertrophy
    85 remnants
    86 resected metastasis
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