GOOD TO KNOW: The ALPPS Procedure - Embracing a New Technique

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Liver transplantation

Background:

• Hepatic resection is the only potentially curative treatment for primary liver tumors and hepatic metastases.
• Liver failure due to insufficient future liver remnant (FLR) is a major complication of extensive hepatectomies.
• The Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) technique addresses this by rapidly increasing FLR hypertrophy, thus lowering postoperative liver failure risk.

Purpose of the Study:

• To present the classic ALPPS right trisectionectomy technique.
• To describe technical variants of ALPPS developed to mitigate early postoperative morbidity and mortality.
• To highlight ALPPS as a method for increasing resectability of otherwise inoperable liver tumors.

Main Methods:

• ALPPS is a two-stage procedure.
• Stage 1 involves right portal vein ligation and in-situ liver partition (falciform ligament splitting), leaving the tumor-bearing hemiliver in situ with preserved arterial, biliary, and venous drainage.
• Stage 2, typically 7-15 days later, involves removal of the tumor-bearing hemiliver after sectioning its vascular and biliary pedicles.

Main Results:

• The ALPPS technique effectively increases the volume of the future liver remnant (FLR).
• This rapid hypertrophy of the FLR is crucial for managing patients with initially unresectable liver tumors.
• Technical modifications have aimed at reducing the high rates of morbidity and mortality associated with early ALPPS procedures.

Conclusions:

• The ALPPS technique offers a therapeutic option for patients with inoperable liver tumors.
• Careful patient selection and tailored technical adjustments are key to achieving better outcomes.
• Increasing numbers of surgeons are adopting the ALPPS technique due to its demonstrated efficacy.