Korean J Hepatobiliary Pancreat Surg.  2016 May;20(2):75-80. 10.14701/kjhbps.2016.20.2.75.

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure for hepatocellular carcinoma with chronic liver disease: a case report and review of literature

  • 1Institute of Liver Studies, Kings Health Partners of King's College Hospital, NHS Foundation Trust, London, United Kingdom. mp1977gr@googlemail.com


The incidence of complications after liver resection is closely related to functional future liver remnant (FLR). The standard approach to augment FLR is surgical or radiological occlusion of the artery or portal vein on the tumor side. Associated liver partition and portal vein ligation for staged hepatectomy (ALLPS) has been introduced as an alternative method to augment FLR. It offers rapid and effective hypertrophy for resecting liver metastases. However, data regarding its application in patients with hepatocellular carcinoma (HCC) with a background of chronic liver disease are limited. Here we describe the use of ALPPS procedure to manage a large solitary HCC with a background of chronic liver disease. The rising incidence of HCC has increased the number of surgical resections in patients with advanced stage liver disease not considered for liver transplantation. We reviewed reported experience of ALPPS in established chronic liver disease and current therapeutic modalities for HCC on a background of chronic liver disease in patients with potential liver insufficiency where tumor burden is beyond liver transplant criteria.


ALPPS; Liver cirrhosis

MeSH Terms

Carcinoma, Hepatocellular*
Hepatic Insufficiency
Liver Cirrhosis
Liver Diseases*
Liver Transplantation
Neoplasm Metastasis
Portal Vein*
Tumor Burden


  • Fig. 1 Arterial phase CT imaging showing the presence of a lesion lying within the right liver segments V/VIII. It measures up to 8 cm showing enhancement, suggesting hepatocellular carcinoma.

  • Fig. 2 CT imaging of lesion post-TACE showing partial response of tumor with small future liver remnant.

  • Fig. 3 Changes in aspartate transaminase level.

  • Fig. 4 Changes in alkaline phosphatase level.

  • Fig. 5 Changes in total bilirubin level.

  • Fig. 6 Post-1st stage ALPPS CT imaging showing significant increase in the volume of the future remnant liver.

  • Fig. 7 The tumor consisted of a moderately differentiated hepatocellular carcinoma with acinar pattern in this field (H&E, ×200).

  • Fig. 8 Background liver showing porto-septal fibrosis with slender and mainly porto-portal septa without parenchymal nodule formation (Gordon and Sweet reticulin staining, ×20).

  • Fig. 9 Post-2nd stage ALPPS CT imaging showing adequate increase of the liver remnant.


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