ALPSS

Q) ALPSS all are true except? (AIIMS 2017 Gi questions) (Liver Surgery MCQs) 

a) ALPPS should not be considered in every patient in whom PVE has failed.

b) CT scan and volumetric assessment is done after POD 7 and proceeded to stage 2 if sFLR greater than 30% (BWR > 0.5%) or 40% (BWR > 0.8%) depending on parenchymal quality

c) Indicated for Large CRLM

d) Is a relative contraindication for patients with hilar cholangiocarcinoma

Ans a)  ALPPS should be considered in every patient in whom PVE or the classic two-stage approach is not feasible or has failed

The limits for safe hepatic resections are usually considered from 20% to 40%, depending on the quality of liver parenchyma (fibrosis, steatosis,
chemotherapy-related liver injury). The lower limit for FLRV is set at 20% in patients with normal livers, 30% to 35% in patients with chemotherapy-related liver injury, and 40% in patients with chronic liver disease

Cut-off values for proceeding to stage 2, usually after 7 to 14 days, are sFLR greater than 30% (BWR > 0.5%) or 40% (BWR > 0.8%) depending on parenchymal quality. ( Ref BG page 1665) 

Currently,CRLM is the most promising indication, especially for bilobar involvement
In hilar cholangiocarcinoma its a relative contraindication as the mortality and morbidity are high

 

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