背景:对于肝肿瘤(原发或转移),手术联合新辅助,或者辅助化疗是治疗的选择,提供长期生存时间和无病时间段(Alvarez等人。,2012)关联肝分区和门静脉结扎,或者ALPPS,这是一种在短时间内增加未来肝脏残留的手术技术,试图避免术后肝功能衰竭(PLF),并在肝脏恶性肿瘤中实现R0切除(Alvarez等人。,2012).
■一名43岁女性,双叶结直肠肝转移。结直肠外科手术在肝脏介入治疗前1年进行,其次是辅助化疗。决定进行三段肝切除术以解决转移。进入外科手术,我们评估了肝实质,未来的肝脏残余组织不足,因此,我们决定执行ALPPS程序。
结论:根据国际注册,结直肠肝转移(CLRM)被认为是ALPPS手术最常见的指征。与门静脉结扎术相比,切除率从50%到80%不等,不可切除的疾病可以通过肿瘤进展来解释。年轻患者(<60岁)的术后死亡率为5.1%,CRLM一般为8%。与非手术方法相比,肿瘤学结果代表了无病生存期和总生存期的增加。
结论:ALPPS程序是一个有趣的方法,患者没有足够的肝残余组织,在无病生存时间方面具有良好的肿瘤学结果,和总体生存率。适当选择病人,精心的术后管理,多学科方法与良好的术后结局相关.
BACKGROUND: For liver tumors (primary or metastases), surgery combined with neoadjuvant, or adjuvant chemotherapy is the treatment of choice, offering long term survival time and disease-free time period (Alvarez et al., 2012) Associating liver partition and portal vein ligation, or
ALPPS, it\'s a surgical technique that increases the future liver remnant in a short period of time, trying to avoid postoperative liver failure (PLF), and achieving R0 resections in liver malignant tumors (Alvarez et al., 2012).
UNASSIGNED: A 43 years old woman with colorectal liver metastases in both lobes. Colorectal surgical procedure was performed 1 year previous the liver intervention, followed by adjuvant chemotherapy. Decision of a tri-segmental hepatectomy was made to resolve the metastases. Into the surgical procedure, we evaluated the liver parenchyma, and the future liver remnant tissue was insufficient, for that reason we decided to perform
ALPPS procedure.
CONCLUSIONS: Colorectal liver metastases (CLRM) are considered the most common indication for
ALPPS procedure according to the international registry. Compared with the portal vein ligation, resection rate varies from 50 to 80%, and the non-resectability disease was explained by tumor progression. Postoperative mortality rate was 5.1% in young patients (<60 years old), and 8% in general for CRLM. Oncologic outcomes represent an increased disease-free survival period and overall survival time compared with non-surgical approach.
CONCLUSIONS: The
ALPPS procedure it\'s an interesting approach to patients with not enough liver remnant tissue, with good oncologic results in terms of disease-free survival time, and overall survival. Appropriate selection of the patient, careful postoperative management, and a multidisciplinary approach are related with good postoperative outcomes.