ALPPS procedure: our experience and state of the art.
OBJECTIVE
The majority of the time extended liver resections cannot be realized because of an insufficient future remnant liver. Baumgart suggests recently combining liver partition and portal vein section for staged hepatectomy, named ALPPS procedure. Our aim is to share our initial experience with ALPPS procedure and to perform the first comprehensive English literature review.


METHODS
From January 2011 until June 2013, 6 patients underwent ALPPS, performing 6 extended right hepatectomies (one with concomitant right colectomy, one with main biliary duct resection).


RESULTS
The present series showed a mean of 110% volume hypertrophy of the future remnant liver achieved with a mean of 15.3 days after ALPPS. One patient experienced severe liver failure, one had biliary leak and one died for postoperative respiratory distress syndrome. After a mean followup of 16.2 months (range 2-30 months) one patient had liver recurrence. In an English literature search, we identified 18 publications describing a mean hypertrophy rate of 85%, a mean morbidity and mortality rate of 35% and 6%, respectively.


CONCLUSIONS
ALPPS is an effective technique used to induce an increased and rapid growth of the future remnant liver, but at the price of a higher morbidity and mortality compared with other conventional procedures.
Benedetto
B
Ielpo
Riccardo
R
Caruso
Valentina
V
Ferri
Yolanda
Y
Quijano
Hipolito
H
Duran
Eduardo
E
Diaz
Isabel
I
Fabra
Catalina
C
Oliva
Sergio
S
Olivares
José Carlos
JC
Plaza
Emilio
E
Vicente
D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology; D003135:Common Bile Duct / Q000473:pathology / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006984:Hypertrophy; D008026:Ligation; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome