title: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): the Brazilian experience.
abstract: BACKGROUND
  Postoperative liver failure consequent to insufficiency of remnant liver is a feared complication in patients who underwent extensive liver resections. To induce rapid and significant hepatic hypertrophy, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently developed for patients which tumor is previously considered unresectable.
  
  
  OBJECTIVE
  To present the Brazilian experience with ALPPS approach.
  
  
  METHODS
  Were analyzed 39 patients who underwent hepatic resection using ALPPS in nine hospitals. The procedure was performed in two steps. The first operation was portal vein ligation and in situ splitting. In the second operation the right hepatic artery, right bile duct and the right hepatic vein were isolated and ligated. The extended right lobe was removed. There were 22 male (56.4%) and 17 female (43.6%). At the time of the first operation, the median age was 57.3 years (range: 20-83 years).
  
  
  RESULTS
  The most common indication was liver metastasis in 32 patients (82.0%), followed by cholangiocarcinoma in three (7.7%). Two patients died (5.2%) during this period and did not undergo the second operation. The mean interval between the first and the second operation was 14.1 days (range: 5-30 days). The volume of the left lateral segment of the liver increased 83% (range 47-211.9%). Significant morbidity after ALPPS was seen in 23 patients (59.0%). The mortality rate was 12.8% (five patients).
  
  
  CONCLUSIONS
  The ALPPS approach can enable resection in patients with lesions previously considered unresectable. It induces rapid liver hypertrophy avoiding liver failure in most patients. However still has high morbidity and mortality.
authors.affiliation: Department of Surgery: Federal University of Maranhao. o.torres@uol.com.br
authors.forename: Orlando Jorge Martins
authors.initials: OJ
authors.lastname: Torres
authors.forename: Eduardo de Souza Martins
authors.initials: Ede S
authors.lastname: Fernandes
authors.forename: Cassio Virgilio Cavalcante
authors.initials: CV
authors.lastname: Oliveira
authors.forename: Cristiano Xavier
authors.initials: CX
authors.lastname: Lima
authors.forename: Fabio Luiz
authors.initials: FL
authors.lastname: Waechter
authors.forename: Jose Maria Assunção
authors.initials: JM
authors.lastname: Moraes-Junior
authors.forename: Marcelo Moura
authors.initials: MM
authors.lastname: Linhares
authors.forename: Rinaldo Danese
authors.initials: RD
authors.lastname: Pinto
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
authors.forename: Marcel Autran Cesar
authors.initials: MA
authors.lastname: Machado
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008026:Ligation; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D055815:Young Adult