ALPPS Procedure (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy)

ALPPS is an advanced two-stage hepatic resection technique designed to overcome insufficient future liver remnant volume in patients with extensive hepatic tumors who would otherwise be inoperable.

In the first stage, the portal vein on the diseased side is ligated and the parenchyma is split along the planned transection line. This induces rapid hypertrophy of the contralateral lobe, often producing a 60 to 80 percent volume increase within seven to fourteen days. The second stage completes the resection of the diseased lobe.

Indications include large colorectal liver metastases, hilar cholangiocarcinoma and selected hepatocellular carcinomas with marginal future liver remnant. Although ALPPS offers complete resection in otherwise unresectable disease, it is associated with significant morbidity and mortality and should be performed in high-volume hepatobiliary centers with strict patient selection.