title: ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure?
abstract: BACKGROUND
  To induce rapid hepatic hypertrophy and to reduce post-hepatectomy liver failure (PHLF), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently developed for patients with a limited future liver remnant. The aim of this study was to further assess the perioperative risk of this procedure and its specific indications.
  
  
  METHODS
  The study was performed between November 2010 and April 2012 for patients undergoing right trisectionectomy by the ALPPS approach. Liver volume, intra- and postoperative complications, including PHLF, and residual tumour status were compared for patients with different diagnoses.
  
  
  RESULTS
  The interval between two operations in nine patients undergoing ALPPS was 13 days (median). Sufficient hepatic hypertrophy was achieved with a volume gain of 87.2 % (median). All patients underwent right trisectionectomy without residual tumours. In contrast to six patients with uneventful intra- and postoperative course, bile leak, vancomycin-resistant enterococcus infection, PHLF and sepsis developed in two of three patients with hilar cholangiocarcinoma as the preoperative diagnosis.
  
  
  CONCLUSIONS
  ALPPS leads to sufficient hepatic hypertrophy within 2 weeks, avoiding PHLF in most patients. In patients with hilar cholangiocarcinoma, ALPPS should be applied with extreme caution due to high morbidity and mortality.
authors.affiliation: General, Visceral and Transplantation Surgery, University Hospital Tuebingen, Tuebingen, Germany. j.li@uke.de
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.forename: Paolo
authors.initials: P
authors.lastname: Girotti
authors.forename: Ingmar
authors.initials: I
authors.lastname: Königsrainer
authors.forename: Ruth
authors.initials: R
authors.lastname: Ladurner
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000601:surgery*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000517:prevention & control*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D018805:Sepsis / Q000517:prevention & control; D016896:Treatment Outcome