Future liver remnant portal or hepatic vein reconstruction at stage I of ALPPS—How far can we push the boundaries?

Abstract

Preservation of the future liver remnant (FLR) vascular integrity has always been considered crucial to achieving successful liver growths after major hepatectomies.Most surgeons appeared therefore reluctant to combine stage I of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) with vascular reconstructions. Here we describe a case series, where we combine parenchymal transection and venous in-or outflow reconstruction of the FLR at stage I of ALPPS.In addition, the cold flush of the FLR or delayed portal vein embolization is applied in selected cases.

Uncommon indications for associating liver partition and portal vein ligation for staged hepatectomy: a systematic review

“…Only a small number of cases with malignant primitive liver pathologies other than HCC and CCC treated with ALPPS approach have been reported in adult patients (http://fp.amegroups.cn/cms/3e50f5ba5e510fa37ad19c5 0610b1139/hbsn-20-355-2.docx). In detail, we reported two cases of hemangiopericytoma, two of epithelioid hemangioendothelioma, and one of undifferentiated pleomorphic embryonal sarcoma and leiomyosarcoma (2,(27)(28)(29)(30)(31). Three patients came from Germany, and one each from Switzerland, the United Kingdom, and Argentina.…”

“…The median time interval between the first and the second ALPPS stage was 10 (ranges, 7-28) days. Only the leiomyosarcoma case has been fully described, with the patient surviving without recurrence at one year after the second stage (30).…”