Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) in patients with advanced liver disease

Abstract

Hepatic resection is the only potential curative treatment for patients with liver malignant disease,
even for primary and metastasic lesions. The possibility of achieving a curative resection is limited by
the future liver remnant and posthepatectomy liver failure (PHLF) is the most feared and severe com- plication. The Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has
been introduced in the latest year as a novel strategy to avoid PHLF and allow the resection in patients
with locally advanced disease previously considered unresectable. This technique is based on the li- gation of the disease liver portal vein and the transection of the hepatic parenchyma. This deviates
portal flow to the non-tumoralliver and avoids cross flow through the parenchyma, which maximizes
the future liver remnantvolume increase. The best candidates for this surgery are those patients con- sidered unresectable because of the size or the quality of the FLR.
Current evidence regarding ALPPS shows promising short-term results. However, it is difficult to analy- ze these results from the oncological point of view because of the variety of diseases, chemotherapy schemes and technique variations among different surgeons. ALPPS is a feasible and safe strategy in experienced hands, which should be taken into account asan option, in properly selected oncologic patients that have been previously evaluated in multidiscipli- nary oncologic teams.
Long-term results are still missing in order to define more clearly which is the role of this new tech- nique.