[Experience of two-staged liver resection (ALPPS)]

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Context:

• Liver surgery often faces challenges with insufficient future liver remnant (FLR) volume.
• Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a two-stage surgical procedure designed to address this limitation.
• This technique aims to induce rapid hypertrophy of the FLR prior to the second stage hepatectomy.

Purpose:

• To evaluate the single-center outcomes of ALPPS procedures.
• To assess the efficacy of ALPPS in achieving sufficient liver hypertrophy.
• To analyze the postoperative complication rates and patient outcomes following ALPPS.

Summary:

• Five ALPPS procedures were performed for liver metastases from colorectal and bladder cancer.
• The surgeries involved various hemihepatectomy types, with some including atypical resections and unsuccessful portal vein embolization.
• All patients achieved significant left liver lobe hypertrophy (>50%) and underwent final hepatectomy, with no cases of severe liver failure, but three experienced postoperative complications, including one mortality.

Impact:

• ALPPS facilitates rapid FLR hypertrophy, enabling R0 resection in challenging liver cancer cases.
• The procedure is associated with a significant postoperative complication rate, necessitating careful patient selection and management.
• Further research is needed to optimize ALPPS protocols and mitigate associated risks.