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Partial ALPPS with a longer wait between procedures is safe and yields adequate future liver remnant hypertrophy
Ann Hepatobiliary Pancreat Surg 2019 Feb;23(1):13-9
Published online February 28, 2019;
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Nagappan Kumar1, Trish Duncan1, David O’Reilly1, Zsolt Káposztás2, Craig Parry3, John Rees3, and Sameer Junnarkar4

1Cardiff Liver Unit, University Hospital of Wales, Cardiff, UK, 2Moritz Kaposi Teaching General Hospital, Kaposvár, Hungary, 3Department of Radiology, University Hospital of Wales, Cardiff, UK, 4Department of Surgery, Tan Tock Seng Hospital, Singapore
Received June 14, 2018; Revised July 23, 2018; Accepted July 26, 2018.
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.
Backgrounds/Aims: Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has generated controversy due to high morbidity and mortality. We present our series of patients with 30-40% parenchymal transection and minimal hilar dissection.
Methods: Patients who had partial ALPPS between April 2015 and April 2016 were included. Patients with colorectal liver metastases (CRLM) had their future liver remnants (FLR) cleared with metastasectomies. The liver was divided along the future line of transection to 30-40%, right portal vein was stapled and divided without extensive hilar dissection, with minimal handling of right liver, which was not mobilised. We preserved the middle hepatic vein. Data were collected prospectively for hypertrophy of the FLR, morbidity and mortality.
Results: Among the 8 patients (age 25-68) investigated, one patient with cholangiocarcinoma had portal vein embolization prior to partial ALPPS. All patients completed two stages with adequate FLR hypertrophy at a median of 28 days. No mortality was found. The median length of stay after stages 1 and 2 was 9 and 9.6 days, respectively. The median increase in FLR was 38%.
Conclusions: A limited transection of 30-40%, minimal hilar dissection and longer wait between stages yielded adequate FLR hypertrophy with low morbidity and no mortality.
Keywords : Liver resection; Future liver remnant; ALPPS; Hypertrophy; Colorectal liver metastases


February 2019, 23 (1)