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| Chance and challenge of associating liver partition and portal vein ligation for staged hepatectomy |
| Fei Xiang a , b , ∗, Ze-Min Hu b |
a Department of General Surgery, Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China
b Department of General Surgery, Zhongshan People’s Hospital, Zhongshan 528403, China
∗ Corresponding author at: Department of General Surgery, Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China.
E-mail address: zyxiangfei@126.com (F. Xiang). |
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Abstract Background: The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was first performed in 2007. The critical patient selection, timing to perform the second stage operation, and minimally invasive technique are three key factors for patient outcomes. The aim of this review is to summarize published data on these three aspects.
Data sources: Studies were identified by searching PubMed for articles published from January 2007 to October 2018, using the keywords “associating liver partition and portal vein ligation for staged hepate- ctomy”or “ALPPS”or “in situ split”. Studies on colorectal liver metastasis (CRLM), perihilar cholangiocar- cinoma (PHC), and hepatocellular carcinoma (HCC) indicated for ALPPS, cutoffvalues to determine the timing of stage 2, as well as modifications of ALPPS were included.
Results: The mortality of ALPPS for CRLM is declining, for PHC is high. In patients with HCC, essential hypertrophy makes the ALPPS safer. However, the degrees of fibrosis affect the hypertrophy. The future liver remnant volume is still the gold standard to start the second stage. Hepatobiliary scintigraphy plays an important role in quantitatively assessing liver function, whereas cutoffvalues need to be further calibrated. Less-invasive ALPPS modifications have increased and led to a decreased mortality.
Conclusions: ALLPS improved the CRLM outcomes; ALPPS is feasible in patients with PHC after failure of portal vein embolization; ALPPS may be an option for HCC patients with major vascular invasion and thrombosis. The simplified and less-invasive ALPPS is the trend.
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2019, Vol. 18 
