ALPPS and simultaneous right hemicolectomy - step one and resection of the primary colon cancer

World Journal of Surgical Oncology

Karl J Oldhafer¹  Marcello Donati²  Alexandros Papalampros²  Kim C Schuetze²  Gregor A Stavrou¹  Mohammad H Fard-Aghaie² 

[1] Semmelweis University, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, Hamburg, 20099, Germany;Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Ruebenkamp 220, Hamburg, 22291, Germany

关键词: colorectal carcinoma;    In situ split;    ALPPS;   

Others  :  1146036
DOI  :  10.1186/s12957-015-0544-3

 received in 2014-09-15, accepted in 2015-03-11,  发布年份 2015

【 摘 要 】

Background

Resection of the liver is often limited due to the volume of the parenchyma. To address this problem, several approaches to induce hypertrophy were developed. Recently, the ‘associating liver partition and portal vein ligation for staged hepatectomy’ (ALPPS) procedure was introduced and led to rapid hypertrophy in a short interval. Additionally to the portal vein occlusion, the parenchyma is transected, which disrupts the inter-parenchymal vascular connections.

Since the first description of the ALPPS procedure, various reports around the world were published. In some cases, due to the high morbidity and mortality, a decent oncologic algorithm is not deliverable in a timely manner. If a patient is to be treated with a liver-first approach, the resection of the primary could sometimes be severely protracted. To overcome the problem, a simultaneous resection of the primary tumor and step one of ALPPS were performed.

Case presentation

A 73-year-old male patient underwent portal vein embolization (PVE) after suffering from a synchronous hepatic metastasized carcinoma of the right colic flexure in order to perform a right trisectionectomy. Sufficient hypertrophy could not be obtained by PVE. Thus a ‘Rescue-ALPPS’ was undertaken. During step one of ALPPS, we simultaneously performed a right hemicolectomy. The postoperative course after the first step was uneventful, and sufficient hypertrophy was achieved.

Conclusion

In order to achieve a macroscopic disease-free state and lead the patient as soon as possible to the oncologic path (with, for example, chemotherapy), sometimes a simultaneous resection of the primary with step one of the ALPPS procedure seems justified. A resection of the primary with step two is not advisable, due to the high morbidity and mortality after this step. This case shows that a simultaneous resection is feasible and safe. Whether other locations of the primary should be treated this way must be part of further investigations.

【 授权许可】

   
2015 Fard-Aghaie et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

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