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ALPPS procedure for two stage liver resection

sdp's picture
sdp
Posts: 178
Joined: Jan 2012

Hi,

Has anyone heard of the ALPPS procedure pioneered by Dr Eduardo in buenos aires, argentina. Also known as liver partition. Hospitals name is hospital Italiano .

It is a two stage resection of the liver , but second resection done within a week of first operation. That way it seems that the timing between resection gets reduced and there is no chance of tumour growing further in between surgeries as you would be off chemo for atleast a month plus . 15 days prior to operation and further 15 days after and then again 15 days prior to next operation. Also , recovery periods are longer,in case the resection is done in a single go.

It was recommended to me by Dr Dave Geller of univ of Pittsburgh medical centre who is a renowned doctor for liver surgery.

This procedure is not offered in India at present. However, in certain europen centres like torino, Italy I believe it is.

If there is anyone who is familiar with this procedure or can ask certain reknowned liver surgeons ? Any information whatsoever is welcome.

Sdp

Lovekitties's picture
Lovekitties
Posts: 3099
Joined: Jan 2010

I have searched the internet and have found only one reference to the ALPPS procedure. It was a topic at a seminar in March of this year:

Moderators:
Dr. Oscar Andriani (Argentina)
Dr. Rogelio Traverso (Argentina)

Use of transplant associated techniques for complex hepatic resection
Dr. William Chapman (USA)

ALPPS - Associated liver partition and portal vein occlusion for stage hepatectomy: A new method to avoid postoperative liver failure
Dra. Victoria Ardiles (Argentina)

Near total liver resection for bilobar liver metastasis
Dr. Marcel Autran Machado (Brazil)

I was unable to find a doctor with the last name Eduardo in Argentina...there are lots with that as a first name.

I found nothing related to the hospital in Torino, Italy on the subject.

I would suggest that you get more details from the referring doctor.

janie1
Posts: 753
Joined: Apr 2011

Does that Dr. Eduardo personally STILL do those surgeries, or did he pioneer it?
Also, I'm not clear on if Dr. Geller at the University of Pittsburgh is a surgeon that does this procedure (since he is a very well known liver surgeon). Or is he recommending someone / someplace else.
Are you saying Dr. Geller would do this for you, and are you just asking here if anyone knows anything about this procedure.
If Dr. Geller does the procedure are you considering having him do it? I've heard many times about his expertise.
Sorry, I don't know about the procedure, but like I said, I have heard good comments about Dr. Geller.
Please keep us updated.

sdp's picture
sdp
Posts: 178
Joined: Jan 2012

Hi,

The procedure is currently not done in the USA . Dr geller, after seeing my scans etc feels I am the right candidate to opt for this procedure. Dr Eduardo santabanes does this procedure in Argentina. His bio data is as follows,

Biography - Eduardo de Santibaes, MD, PhD, FACS
 
 
Eduardo de Santibaes, MD, PhD, FACS
 
 
Eduardo de Santibaes graduated from the University of La Plata in Buenos Aires, Argentina, receiving the gold medal, the highest recognition awarded by the University for Outstanding Performance, his overall grade average being 9.27. He completed his surgical residency at the Hospital Italiano de Buenos Aires and later became chief of residents there.
He completed a research fellowship at the University Health Center of Pittsburgh School of Medicine (where Dr. Thomas Starzl was the chairman) prior to beginning his career as a surgeon specialized in transplantation and hepatobiliary cancer.
In 1988 he was recognized as one of Ten Outstanding Young People by the Junior Chamber of Buenos Aires, Argentina.
Together with his team, he performed the first adult liver transplantation in Argentina in January 1988 and the first liver living related donor transplantation in 1991.
Eduardo de Santibaes directed the laboratory of experimental surgery at the Hospital Italiano de Buenos Aires between 1989 and 1990. He and his team still continue their work there.
He was president of the Argentinean Transplantation Society between 1991 and 2000.
He created a fellowship in HPB and Liver Transplantation in 1992. Since then, he has been training surgeons from Argentina and other parts of the world.
In 2001 he founded the Argentinean Chapter of the Argentinean IHPBA (CA - IHPBA) together with other HPB surgeons.
He was President of the IHPBA Argentinean Chapter (2002- 2003)
He is Secretary-General of the Argentinean Academy of Surgery (2004 - 2008).
He is President-Elect of the 2008 Argentinean Congress of Surgery and Chairman of the IHPBA 2010 World Congress.
He has been the Chairman of the HPB and Liver Transplantation Unit at the Hospital Italiano de Buenos Aires since 1987. His unit has performed more than 700 transplants and over 1500 hepatic resections. The unit is the most active in Latin America, performing more than 1300 procedures per year.
He is an active clinical researcher and has contributed to the literature with his numerous papers and book chapters. He has given more than 500 national and international presentations and lectures. He is on the Editorial Board of many leading journals (including HPB Journal).
He became Full Professor and Chairman at the University of Buenos Aires in 2005.
He is a Fellow of the American College of Surgeons and active member of other professional organizations.
Dr Eduardo de Santibaes became an Honorary Fellow of the American Surgical Association in April, 2007.

Hospital is hospital Italiano,in buenos Aries, Argentina. Research paper for this is "Playing Poh-doh to prevent postoperative liver failure- the ALPPS approach"

I couldn't access the contents of this research paper.

Sdp

janie1
Posts: 753
Joined: Apr 2011

That is an impressive bio. Since I live in the U.S., I, personally, would take Dr. Geller's recommendation pretty seriously. Sorry, probably no one here has any knowledge about this procedure. It hasn't come up in discussion since I've been reading for the past year.
I wish you the best in whatever your decision is. This is so complex, and I know you have been working and researching very hard about this.

mmautran
Posts: 1
Joined: Jul 2012

This technique is so-called ALPPS, Associating Liver Partition and Portal vein ligation for Staged hepatectomy. It is a new technique for two-stage liver resection using liver partitioning during the first stage. Liver partitioning avoids portal collateral and enhances future liver remnant hypertrophy. Therefore the second stage can be performed in only 7 days instead 3 to 4 weeks. This technique has been described by a german group [1] and published by Eduardo de Santibanes [2]. To date only few cases has been done so far - less than 100 worldwide. This procedure has been done by laparoscopy by our Group in Brazil [3].

References

1.Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255:405–414.
2. de Santiba˜nes E, Clavien PA. Playing Play-Doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg. 2012;255:415–417.
3. Machado MA, Makdissi FF, Surjan RC. Totally Laparoscopic ALPPS Is Feasible and May Be Worthwhile.Ann Surg. 2012 Jul 26.

Prof. Marcel Autran Machado
dr@drmarcel.com.br

managar
Posts: 3
Joined: Jul 2012

Hi Sdp, I cannot see my post now or the reply you sent me. Anyway, my mother-in-law sent your regards to Dr. Eduardo de Santibañes, he remembered you and your case. He told us that his team has done about 30 of these surgeries at Hospital Italiano (Buenos Aires). How was your second surgery? Her first procedure is scheduled for 10 August (next Friday) in order to have her liver tumor resected. I will let you know how it went. Please keep me posted on your recovery.
I hope you are well.

Regards,

Maria

sdp's picture
sdp
Posts: 178
Joined: Jan 2012

Hi,

Neither do I, am in hospital recovering from the operations.

I will describe it in detail later.

Still need to RFA one tumour later.

Sdp

managar
Posts: 3
Joined: Jul 2012

I am glad you are OK.
She will be hospitalized for about 20 days, the first 2 being at Intensive Care.

I'll write soon.

janie1
Posts: 753
Joined: Apr 2011

Sdp, i wondered if you had the surgery. Good for you. Thanks so much for checking in here. We weren't much help. But I am happy for you to have gone to the extremes to beat this. I hope you have quick healing. Please keep us updated. It is great to know that some doctors are willing to think outside the box. Will you be able to go back home soon? What is the next step and can that be done in
India?

Managar........best wishes to you, too.
Please let us know how you are doing?

lds41
Posts: 1
Joined: Aug 2014

Just wondering if you had the alpps procedure done. wondering about it for my dad. thanks

sdp's picture
sdp
Posts: 178
Joined: Jan 2012

I didn't have to get an ALPPS at that time and the dr managed in one surgery

had recurrences thrice - in liver. - twice had ablation and one more time had a resection after the first resection

pl see my signature - also pl read on dr hans Schlitt formthe ALPPS 

tanstaafl's picture
tanstaafl
Posts: 1061
Joined: Oct 2010

Sdp, how much cimetidine and/or celebrex have you had so far?

sdp's picture
sdp
Posts: 178
Joined: Jan 2012

i have had a few months of cemotidine 

 

but had a reoccurenxe few months ago even after the cemitidine

tanstaafl's picture
tanstaafl
Posts: 1061
Joined: Oct 2010

Those months of cimetidine should reduce, perhaps completely stop, new cancer seedlings  (for CA19-9 and CSLEX1/CEA both positive) that were generated during the treatment period but would do less for pre-existing seedlings, and nothing for later seedlings somewhat after the treatment period.    The perioperative period is a extra rich benefit period due to immune suppression from surgery.

In my wife's case, before her first surgery and any chemo drugs other than cimetidine, she had a substantial immunological event that necrosed some of her existing cancer metastases but not all. She had some other supplements too. She did not form new metastatic sites where oncologists would expect new mets to light up her PET scan in a year or so, spread from a large pre-existing para aortic lymph node cluster.  Any met formation that she gets now I interpret as likely the sprouting of old seedlings from before diagnosis (2010) because she has been on cimetidine continuously for 4+ years since diagnosis, and daily chemo 10 weeks later.  

Any cycling of even part of her immunochemo treatment is followed by rapid CEA rises, perhaps a met grown from the old seedlings.  These rises we've hammered back down with full formula plus celecoxib during the last 19 months although probably incomplete elimination.  We thin her blood to minimize the CV risks of celecoxib.   

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