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Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure
Published on: August 14, 2017
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The ALPPS procedure for hepatocellular carcinoma.
G Vennarecci1, A Laurenzi1, G B Levi Sandri1
1Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy.
Summary
The Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure rapidly increases future liver remnant (FLR) volume. This technique enables major liver resections by ensuring sufficient FLR in patients with liver tumors.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Liver regeneration
Background:
- Major hepatic resections are limited by future liver remnant (FLR) volume.
- Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a novel procedure.
- ALPPS induces rapid FLR hypertrophy in patients with unresectable liver tumors.
Purpose of the Study:
- To evaluate the efficacy of ALPPS in inducing FLR hypertrophy.
- To assess the safety and feasibility of the ALPPS procedure.
- To determine the time interval required to achieve a sufficient FLR.
Main Methods:
- ALPPS involves in-situ liver splitting along the main portal scissura or falciform ligament.
- Portal vein ligation is performed to induce hypertrophy of the contralateral FLR.
- The procedure is conducted in two stages.
Main Results:
- Median FLR volume increased by 18.7% after the first step and 38.6% after the second step.
- First step: median operative time 300 min, no transfusions, 150 cc blood loss.
- Second step: median operative time 180 min, 50 cc blood loss, no intraoperative transfusions required. All patients survived 9-month median follow-up.
Conclusions:
- ALPPS is a feasible strategy for achieving adequate FLR in a short time.
- The technique is effective even in cirrhotic livers.
- ALPPS facilitates major liver resections previously considered non-resectable.
