Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (Alpps) for Large Hepatocellular Carcinomas

Abstract

Background: ALPPS was developed to induce accelerated future liver remnant (FLR) hypertrophy in order to increase hepatic tumour resectability and reduce the risk of post hepatectomy liver failure(PHLF).The only means of achieving long-term survival in hepatocellular carcinoma is complete tumor resection or liver transplantation. Patients with large hepatocellular carcinomas are currently not considered for liver transplantation.So, ALLPS is indicated in selected patients to induce rapid hepatic hypertrophy. Methods: Three patients initially presented with tumor measuring around 20-15 cm × 10-15cm in the right lobe of the liver. The liver was cirrhotic but liver function was normal in all 3 cases. CTvolumetry done and future liver remnant volume(FLRV) is < 40%. So we did ALLPS procedure to induce rapid and maximum hypertrophy in FLRV. During the first part of the procedure the right portal vein was ligated with complete liver parenchymal transection 1cm right of falciform ligament. The second procedure performed after 10-14 days with the division of right hepatic artery, right bile duct, right hepatic vein and liver segments 4-8 with tumor were removed. Results: >80% hypertrophy in FLRV was achieved in 10-14 days.Tumour was resected without developing PHLF . After 1 year follow up, patients are doing well with no signs of liver failure and recurrence Conclusion: ALPPS leads to sufficient hepatic hypertrophy within 2 weeks, avoiding PHLF in most patients. ALPPS should be considered in selected patients with large hepatocellular carcinomas.