A new surgical technique allowed Prof. Dr. Martin Loss, Chief Physician of the Clinic for General and Visceral Surgery at Vivantes Friedrichshain Hospital, to remove a previously inoperable liver tumor. A few years ago, he was involved in the development of the so-called "in-situ splitting", also known as the ALPPS procedure*.
What exactly is the procedure for such an operation?
Two operations are necessary: In the first operation, the healthy liver tissue is separated from the tumorous liver tissue. The blood supply to the tumor-affected part is severely curtailed, but it still remains in the body and continues to function in a limited way. Now the ability of the liver to regenerate comes into play: Due to the severe loss of performance of the diseased part, the healthy part receives a pronounced growth spurt and grows to almost double its volume within a few days. This part can then take over the work of the liver on its own. In a second operation, the tumor located in the liver is removed.
It sounds as if the liver were an independent organism! How does it do that?
The new surgical technique of the ALPPS procedure reveals a special characteristic of the human liver: it regenerates.
The liver is actually unique in this respect and is the only organ in the human body that has the ability to regenerate so strongly. The kidney, for example, could not do this, but would permanently reduce its performance. This peculiarity of the liver has been known since ancient times and has been handed down in the Prometheus legend. It is also used for other interventions, for example for "portal vein embolization", in which a vessel of a liver lobe is also closed. In this case, however, regrowth of the unaffected side of the liver takes considerably longer. Such rapid regeneration is only possible with ALPPS because the blood flow in the vessels is cut off by severing the liver.
In which cases is the method suitable, when is it not applicable?
The operation can also be performed in the case of a very advanced invasion of the liver by cancer, for which previously only palliative treatment was used. Thus, the curative perspective of the procedure is new. An important prerequisite is that patients are fit enough to be operated on in the first place. The risk increases with age and the procedures should only be performed in specialized centers. The two procedures, which take place in a short period of time, can be very stressful for the patients.
What are the prognoses after such an operation?
That depends, of course, on the patient and on how advanced the tumor already is. In any case, we can open up new opportunities and increase the quality of life through the curative approach.
It is crucial that patients learn about this option in the first place and do not receive chemotherapy instead, which only "controls" the cancer. They should present themselves at specialized centers that are aware of all the therapeutic options and, in the best case, offer the procedure themselves.
Where was the in situ splitting method first performed?
At the Clinic and Polyclinic for Surgery in Regensburg, I was able to participate in the development of the procedure in 2007 and use it for the first time worldwide together with Prof. Dr. Hans J. Schlitt. After that, it was adopted by many university hospitals and liver surgery centers, and I am pleased to be able to offer this still rarely used surgical technique to our patients at the Vivantes Friedrichshain Hospital as well.
"In-situ splitting" means cutting the branch of the portal vein, which cuts off the blood supply in the diseased part of the liver and allows rapid liver growth of the healthy part. At the same time, the liver is cut ("splitting"). In a second operation, the diseased half of the liver is then removed. This is what the abbreviation ALPPS stands for: "Associating Liver Partition and Portal vein Ligation for Staged hepatectomy".