Associating liver partition and portal vein ligation for staged hepatectomy: A surgical technique for liver resections

Behnam Sanei, Saba Sheikhbahaei, Mohammad Hossein Sanei, Amin Bahreini, Hamid Reza Jafar


Background: Associating liver partition and portal vein ligation for staged  hepatectomy (ALPPS) is a novel surgical technique liver resection in traditionally nonresectable primary intrahepatic tumors or colorectal liver metastases. Materials and Methods: From June 2013 to March 2014, patients with primary  tumor of liver or colorectal tumors with liver metastasis were selected to evaluate whether they met the initial criteria for ALPPS procedure. Results: Nine patients enrolled in the study with primary diagnoses of colon and rectosigmoid cancer, carcinoid tumor, gastrointestinal stromal tumor of small intestine, hepatocellular carcinoma, and pancreatic neuroendocrine tumor (PNET). Four candidates excluded from the study prior or during the first step operation due to fatty liver, hepatic fibrosis, peritoneal seeding, and multiple small intestine metastases. Five patients underwent two stages of ALPPS with the interval of  about 1 week. Liver hypertrophy was 100% among our candidates after the  initial step. One postoperative death happened because of massive pulmonary thromboembolism. Recurrence of liver metastasis was seen in one patient. Hepatic failure Class B and A were observed in two patients which did not  progress during follow?up period. One patient developed an enterocutaneous fistula. Discussion: We recommend to use 2 organ bags, one for wrapping right lobe and the other one for covering visceral organs and also do liver biopsy in suspicious cases of damaged liver parenchyma and laparoscopic exploration of abdomen for seeding and multiple metastases prior to laparotomy. Conclusion: As the procedure has not been well established and verified by oncologists yet, further studies are required to define the exact indications of ALPPS.

Key words: Associating liver partition and portal vein ligation for staged hepatectomy, colorectal cancer, liver metastasis

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