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Updated: Mar 17, 2026
Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure
Published on: August 14, 2017
ALPPS Procedure in Insufficient Hypertrophy After Portal Vein Embolization (PVE)
T F Ulmer1, C de Jong2, A Andert3
1Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany. f.ulmer@ukaachen.de.
Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) offers a viable solution for patients with insufficient future remnant liver (FLR) hypertrophy after portal vein embolization (PVE). This approach can achieve significant FLR growth, though it carries notable complication and mortality risks.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Liver Regeneration
Background:
- Major liver resections are limited by future remnant liver (FLR) volume and function.
- Portal vein embolization (PVE) is standard for FLR hypertrophy but has a 20-30% failure rate.
- Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is an alternative for insufficient FLR hypertrophy.
Purpose of the Study:
- To evaluate the efficacy and outcomes of ALPPS in patients with insufficient FLR hypertrophy following PVE.
- To analyze FLR volume changes, complications, mortality, and survival rates after ALPPS in this cohort.
Main Methods:
- Retrospective analysis of nine patients undergoing ALPPS after failed PVE.
- Computed tomography (CT) volumetry to assess FLR volume changes before and after PVE and after the first stage of ALPPS.
- Analysis of complications, 30-day mortality, and overall survival (OS).
Main Results:
- Significant FLR volume increase of 77.7% (FLR/TLV: 34.9%) within 9 days after the first ALPPS stage, despite prior insufficient PVE.
- Major complications (Grade > IIIb) occurred in 33% of patients; 30-day mortality was 11.1%.
- One- and 2-year OS rates were 78% and 44%, respectively, with 44.4% of patients alive at a median of 33.4 months.
Conclusions:
- ALPPS can be a suitable alternative or last resort for potentially curative treatment in patients with insufficient FLR hypertrophy post-PVE.
- High morbidity and mortality rates associated with ALPPS require careful consideration.
- Long-term oncological outcome data for ALPPS in this specific patient group are still limited.
