Recently, the “International Journal of Surgery” (IF: 13.40) published the research results of the team of Lu Xin and Xu Yiyao of the Department of Liver Surgery of PUMCH on their investigation of ALPPS (associating liver partition and portal vein ligation for staged hepatectomy). The research team conducted a bibliometric analysis of the evolution of ALPPS-related publications from 2012 to 2021 and pointed out future directions for research on the procedure.

Invented by Dr. Hans Schlitt of Germany in 2007, ALPPS is known as “one of the most groundbreaking innovations in liver surgery.” This surgery can induce hypertrophy of liver remnants so that patients with unresectable or borderline resectable liver cancer can have the opportunity of radical resection. However, the mortality rate and complication rate of surgery are high. In recent years, ALPPS has rapidly gained traction worldwide, and related studies have increased year by year, but most of them are single-center studies, and a comprehensive summary and sorting is yet to be made.

This study systemically retrieved the Web of Science database and included 486 ALPPS-themed articles published between 2012 and 2021. Measured by the nationality of the author(s), China accounts for the largest proportion of those publications, followed by Germany and the United States.

▲Visualized results of keyword

The study was the first to use the IDEAL (idea, development, exploration, assessment, long-term study) framework to classify studies related to ALPPS. The results showed that most studies were still in the first three stages under the IDEAL framework; given the fewer studies in Stage 4 (long-term monitoring and follow-up), more long-term follow-up studies are needed to draw a meaningful conclusion. It has been shown that ALPPS shortens the waiting time for surgery, improves tumor resection rate, and prolongs survival time compared with the conventional two-stage hepatectomy.

▲Classification results under the IDEAL framework

The study suggests hot topics for future ALPPS studies, such as multi-center cooperation, the exploration of the mechanism behind surgery-induced liver tissue regeneration, and the long-term benefits of patients after surgery.

In recent years, the team has conducted a series of studies on perihilar cholangiocarcinoma and ALPPS and published 32 papers in prestigious medical journals, including the “New England Journal of Medicine”. Up till now, the Department of Liver Surgery, PUMCH has performed 36 ALPPS surgeries, all of which have successfully achieved safe resection of large tumors, prolonging the survival time of patients. The team led by Associate Professor Wang Xuan of the Department of Radiology measured the liver remnant volume based on preoperative and postoperative imaging to dynamically monitor liver regeneration, which is necessary to perform the ALPPS procedure.

Translated by Liu Haiyan

Edited by Xu Haifeng and Wang Yao