Ann Hepatobiliary Pancreat Surg.  2017 Aug;21(3):151-156. 10.14701/ahbps.2017.21.3.151.

Two cases of ALPPS procedure: simultaneous ALPPS and colorectal resection and ALPPS procedure for hepatic malignancy larger than 15 centimeter

• Choi YI
• Moon HH
• Shin DH

• KMID: 2389992
• DOI: http://doi.org/10.14701/ahbps.2017.21.3.151

Abstract

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been introduced as a new surgical technique to increase future liver remnant in patients with marginal liver volume contemplating major liver resection. We herein present two cases. Case 1: a 68-year-old male patient with colorectal liver metastasis was referred to our department. The future liver remnant (FLR) was 22%. We performed first-stage ALPPS and colorectal surgery concurrently and second stage operation was performed 8 days later. The patient discharged 28 days after the first-stage ALPPS procedure. Case 2: a 69-year-old male patient with a huge hepatic mass was referred for hepatic surgery. The FLR was 19%. After the first stage of the ALPPS procedure, acute renal failure and posthepatectomy liver failure occurred. The patient began to recover on the 5th postoperative day. At 10 days after the first stage, the patient completed the second-stage procedure. The patient discharged 23 days after the first-stage ALPPS procedure. So far many studies are currently underway to identify factors associated with the morbidity and mortality of the ALPPS procedure, it is necessary to continue follow-up studies and observe the results.

Keyword

Posthepatectomy liver failure; Future liver remnant; Staged hepatectomy

MeSH Terms

Acute Kidney Injury
Aged
Colorectal Surgery
Follow-Up Studies
Hepatectomy
Humans
Ligation
Liver
Liver Failure
Male
Mortality
Neoplasm Metastasis
Portal Vein

Figure

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  Fig. 1 Preoperative computed tomography shows the largest metastasis located at the segment 6, measuring 6.5 cm×5.5 cm×6 cm.

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  Fig. 2 Preoperative computed tomography after 4 months, shows that the sizes of the hepatic metastases decreased, with the largest one measuring 3.5 cm×3 cm.

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  Fig. 3 Intraoperative photograph shows the extents of liver resection were marked.

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  Fig. 4 Intraoperative photograph shows that the right hepatic artery and right hepatic vein were marked with vessel loops.

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  Fig. 5 Computed tomography volumetry on day 7, after the first-stage operation revealed future liver remnant volume was 35% of the total liver volume.

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  Fig. 6 Gross photograph of the specimen revealed seven metastatic adenocarcinomas, with the largest one measuring 5.5 cm×3.3 cm.

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  Fig. 7 Computed tomography volumetry showed that the total liver volume was 2,044 ml and the future liver remnant volume was 385 ml (19% of the total liver volume).

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  Fig. 8 Abdominal CT showed significant hypertrophy of the left lateral section.

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  Fig. 9 Histopathology confirmed a 17 cm×14 cm×11 cm probably metastatic hepatoid adenocarcinoma from the stomach.

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