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Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure
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Hypertrophy and Liver Function in ALPPS: Correlation with Morbidity and Mortality.

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Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can lead to significant posthepatectomy liver failure (PHLF). Functional liver assessment is crucial before considering ALPPS due to rapid volume gain not equating to functional recovery.

Keywords:
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Area of Science:

  • Hepatobiliary surgery
  • Surgical oncology
  • Liver transplantation

Background:

  • Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) aims to reduce posthepatectomy liver failure (PHLF) in extended hepatectomies.
  • However, ALPPS is associated with higher morbidity and mortality rates compared to conventional methods.
  • Limited data exist on PHLF incidence and functional assessment following ALPPS.

Purpose of the Study:

  • To review published data on the incidence of PHLF after ALPPS.
  • To assess liver function following ALPPS and its modifications.
  • To identify strategies for avoiding PHLF in ALPPS procedures.

Main Methods:

  • Systematic review of literature on ALPPS and liver failure.
  • Literature search conducted in PubMed, with article evaluation, selection, and tabulation.
  • Analysis of studies on PHLF incidence and functional assessment after ALPPS.

Main Results:

  • 326 articles met selection criteria; PHLF criteria (ISGLS) were inconsistently applied.
  • PHLF occurred in approximately 30% of patients after stage 2 of ALPPS.
  • Hepatobiliary scintigraphy revealed a discrepancy between liver volume gain (100%) and functional gain (50%), with immature liver histology observed.

Conclusions:

  • ALPPS is associated with high rates of PHLF, morbidity, and mortality.
  • Discrepancy between volumetric and functional liver growth explains compromised liver function.
  • Functional assessment is essential, and ALPPS should be performed with caution.