Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)—pushing the envelope in modulation of future liver remnant before major hepatectomy

摘要

Insufficient future liver remnant (FLR) is an important factor that precludes patient from upfront major liver resection as it predisposes to post-hepatectomy liver failure and mortality. As such, augmentation of FLR by portal vein embolization (PVE) was the conventional approach to improve the safety profile of major hepatectomy. In recent years, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been popularized as an alternative approach for FLR augmentation ( , ). However, the initial inception of the ALPPS procedure was met by criticism for its high incidence of procedure-related morbidity, such as bile leakage and sepsis ( ). In light of this issue, an international registry was set up for collection of cases and experience around the world and soon after that, the first International Expert Meeting was held in Hamburg in 2015 that led to the publication of eight recommendations on terminology of the procedures, indications and techniques for ALPPS ( ). Two years later, a pre-congress meeting was held during the EHPBA (European Hepatopancreatobiliary Association) 12 Annual Congress in Mainz, Germany to celebrate the 10 Anniversary of ALPPS ( ) since the first case was performed by Prof. Hans Schlitt a decade ago ( ). During this meeting, ten different aspects on ALPPS were covered including surgical anatomy, underlying mechanisms, perioperative assessment of liver function, technical approach, indications and its effectiveness in comparison to two-stage hepatectomy.