The ALPPS procedure for hepatocellular carcinoma

G. Vennarecci, A. Laurenzi, G. B. Levi Sandri, E. Busi Rizzi, M. Cristofaro, M. Montalbano, P. Piselli, A. Andreoli, G. D'Offizi, G. M. Ettorre

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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.

Original languageEnglish
Pages (from-to)982-988
Number of pages7
JournalEuropean Journal of Surgical Oncology
Issue number8
Publication statusPublished - 2014


  • HCC
  • Liver resection
  • Portal vein embolisation
  • Two stage hepatectomy

ASJC Scopus subject areas

  • Oncology
  • Surgery


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