Modified ALPPS Procedure

Abstract

AbstractIn patients with hepatobiliary malignancies located around the hepatic hilum or those with multiple metastatic lesions, a major hepatectomy is the only curative treatment. A major hepatectomy functions to remove tumor cells concomitant with the hemi-liver or liver parenchyma; however, there is a risk of insufficient remnant liver volume, which might cause postoperative morbidity and mortality in these extended hepatectomies. To overcome this problem, Makuuchi et al. first introduced preoperative portal vein embolization (PVE), which increases the volume of the future liver remnant (FLR), allowing extended hepatectomy to be performed safely. However, there is a maximum volume increase in PVE of approximately 40%. The associating liver partition and portal vein ligation for the staged hepatectomy (ALPPS) procedure was first introduced in 2012, and was shown to increase the FLR by up to 80%. Initially, the major problem of the ALPPS procedure was a high morbidity and relatively high mortality compared to these of PVE. To overcome this problem, various modifications of the ALPPS procedure have been proposed, and satisfactory results have been reported. In this section, various modified ALPPS procedures and their results are presented.