The Evolution of Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy

Abstract

Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy is a cutting-edge surgical technique for resection of hepatic malignancies that has piqued the interest of the international hepatobiliary community. Patients with insufficient future liver remnants, many of whom are considered unresectable via other methods, have the possibility of being cured with this treatment. The main issues; howbeit include, increased perioperative morbidity and mortality as well as both early and rapid disease recurrence. However, with continuous improving of patient selection, optimizing stage 2 operation times and refined operative techniques this has led to reduced morbidity and mortality rates. As for its usage, the most frequent indication is colorectal liver metastasis (CRLM); in which, the results in CRLM have shown higher resectability; however, it has a comparable complication rate to two-stage hepatectomy. Conversely, perihilar cholangiocarcinoma and hepatocellular carcinoma have terrible outcomes; although, with technical refinement and better patient selection good outcomes are achievable. Herein, we summarized the current evidence based of the application of ALPPS in real-life practice, including the potential complications related to this procedure.