Posthepatectomy liver failure: A big surgery within infection is a bad combination

Abstract

Introduction: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel 2stage technique intended to induce rapid growth of the future liver remnant (FLR). Initial reports of a 12% mortality rate have sparked debate regarding the safety of the procedure. Case presentation: A 64 year old male was planned for a right-sided hemi-hepatectomy due to colorectal cancer liver metastases. Intra-operatively it was decided to convert to an ALPPS due to unexpectedly small segments 2e4. Postoperative serum laboratory tests indicated an acute liver failure and radiological imaging showed no sign of arterial blood flow to the right hemi-liver. A CT examination on post-operative day 3 revealed that the FLR had increased from 290 to 690 ml in 3 days (138% growth). In the following days serum values gradually improved and stage 2 was carried out on post-operative day 7. The rest of the hospital stay was uneventful and the patient made a full recovery. Conclusion: ALPPS is a fascinating advancement in liver surgery. Despite severe post-operative complications, in properly selected cases it provides successful outcomes that other modalities of treatment cannot offer.