The ALPPS procedure for hepatocellular carcinoma.
BACKGROUND
The main limiting factor to major hepatic resections is the amount of the future liver remnant (FLR). Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a procedure which induces a rapid hypertrophy of the FLR in patients with non-resectable liver tumours.


METHODS
ALPPS is a surgical technique of in-situ splitting of the liver along the main portal scissura or the right side of the falciform ligament, in association with portal vein ligation in order to induce a rapid hypertrophy of the left FLR.


RESULTS
The median FLR volume increase was 18.7% within one week after the first step and 38.6% after the second step. At the first step the median operating time was 300 min, blood transfusions were not required in any case, median blood loss was 150 cc. At the second step median operating time was 180 min, median blood loss was 50 cc, none of the patients required intra-operative blood. All patients are alive at a median follow up of 9 months.


CONCLUSIONS
This novel strategy seems to be feasible even in the context of a cirrhotic liver, and demonstrates the capacity to reach a sufficient FLR within a shorter interval of time.
Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy. Electronic address: gvennarecci@scamilloforlanini.rm.it.
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G
Vennarecci
Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy.
A
A
Laurenzi
Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy.
G B
GB
Levi Sandri
Division of Radiology, S. Camillo Hospital, Rome, Lazio, Italy.
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E
Busi Rizzi
Division of Radiology, S. Camillo Hospital, Rome, Lazio, Italy.
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M
Cristofaro
Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
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Montalbano
Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
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P
Piselli
Hepatology, S. Camillo Hospital, Rome, Lazio, Italy.
A
A
Andreoli
Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
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G
D'Offizi
Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy.
G M
GM
Ettorre
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008026:Ligation; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D014057:Tomography, X-Ray Computed
ALPPS; HCC; Liver resection; Portal vein embolisation; Two stage hepatectomy