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ALPPS in a patient with periductal infiltrating intrahepatic cholangiocarcinoma
Ann Hepatobiliary Pancreat Surg 2017 Nov;21(4):223-7
Published online November 30, 2017
Copyright © 2017 Ann Hepatobiliary Pancreat Surg.

Sumin Ha1, Abdulwahab A Alshahrani1,2, and Shin Hwang1

1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,2Multi Organ Transplant Center, King Fahad Specialist University Hospital, Dammam, Saudi Arabia
Received September 4, 2017; Revised September 5, 2017; Accepted September 5, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is a novel method to prevent post-hepatectomy hepatic failure. We present a case of periductal infiltrating intrahepatic cholangiocarcinoma undergone ALPPS, that was conducted as intraoperative choice instead of conducting preoperative portal vein embolization (PVE). A 65-year-old male patient was to undergo extended right posterior sectionectomy, but the operation plan was changed to conduct right hepatectomy with/without bile duct resection due to invasion of the right hepatic duct. After deciding to conduct ALPPS, we stopped further perihilar dissection and liver was transected. The right portal vein was ligated and Surgicel was densely packed between the transected hemilivers. There was rapid regeneration of the left liver on computed tomography follow-up, thus the second-stage right hepatectomy was conducted 10 days after the first-stage operation. Bile duct resection (BDR) was not performed due to heavy perihilar adhesion and inflammation, but fortunately tumor-negative bile duct resection margin was achieved after meticulous dissection. This patient recovered uneventfully and discharged nine days after the second-stage right hepatectomy. Thereafter he underwent concurrent chemoradiation therapy. He is doing well so far without evidence of tumor recurrence for 20 months after operation. In conclusion, this case suggests that ALPPS may be applied to an unexpected situation requiring PVE, but ALPPS is not recommend for treatment of perihilar malignancy requiring BDR. (Ann Hepatobiliary Pancreat Surg 2017;21:223-227)
Keywords : Infiltrating intrahepatic cholangiocarcinoma; Hepatic failure; Hepatectomy; Portal vein embolization; Liver partition


November 2018, 22 (4)