Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy: A Better Approach to Treat Patients With Extensive Liver Disease.

Abstract

Liver resection is the treatment of choice and a hope for cure for patients with malignant liver tumors. Resection is many times limited by the amount of future liver remnant, with liver failure being the most severe complication after major resections. To minimize this risk and expand resectability, portal vein occlusion of the tumorbearing lobe is used to redistribute portal flow and induce hypertrophy of contralateral healthy parenchyma. Right portal vein embolization (PVE) is best used before surgery when the future liver remnant is tumor free, while portal vein ligation (PVL) is usually applied as part of 2-stage procedures for patients with bilobar disease who initially require tumor removal in the liver remnant. Around 20% to 40% hypertrophy can be achieved in 8 to 12 weeks with these strategies. However, up to 40% of patients never arrive to tumor resection either because of disease progression or insufficient hypertrophy during these long interval periods. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) approach has emerged as an innovative 2-stage hepatectomy developed in Germany and characterized by a short interval between both surgical procedures. 1 Briefly, during the first stage, the liver parenchyma is divided in 2 hemilivers and PVL of the diseasedhemiliverisperformed.Oncesufficienthypertrophy