ALPPS: Challenging the concept of unresectability - A systematic review

Kimberly A. Bertens, Jeffrey Hawel, Kalvin Lung, Suzana Buac, Karen Pineda-Solis, Roberto Hernandez-Alejandro*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


Introduction: Hepatic resection for malignancy is limited by the amount of liver parenchyma left behind. As a result, two-staged hepatectomy and portal vein occlusion (PVO) have become part of the treatment algorithm. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently described as a method to stimulate rapid and profound hypertrophy. Materials and methods: A systematic review of the literature pertaining to ALPPS was undertaken. Peer-reviewed articles relating to portal vein ligation (PVL) and in situ split (ISS) of the parenchyma were included. Results: To date, ALPPS has been employed for a variety of primary and metastatic liver tumors. In early case series, the perioperative morbidity and mortality was unacceptably high. However with careful patient selection and improved technique, many centers have reported a 0% 90-day mortality. The benefits of ALPPS include hypertrophy of 61-93% over a median 9-14 days, 95-100% completion of the second stage, and high likelihood of R0 resection (86-100%). Discussion: ALPPS is only indicated when a two-stage hepatectomy is necessary and the future liver remnant (FLR) is deemed inadequate (<30%). Use in patients with poor functional status, or advanced age (>70 years) is cautioned. Discretion should be used when considering this in patients with pathology other than colorectal liver metastases (CRLM), especially hilar tumors requiring biliary reconstruction. Biliary ligation during the first stage and routine lymphadenectomy of the hepatoduodenal ligament should be avoided. Conclusions: A consensus on the indications and contraindications for ALPPS and a standardized operative protocol are needed.

Original languageEnglish (US)
Pages (from-to)280-287
Number of pages8
JournalInternational Journal of Surgery
StatePublished - Jan 1 2015
Externally publishedYes


  • Hepatectomy
  • In situ split
  • Portal vein occlusion
  • Two-stage hepatectomy

ASJC Scopus subject areas

  • General Medicine


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