World Journal of Surgery

, Volume 38, Issue 6, pp 1510–1519 | Cite as

ALPPS Offers a Better Chance of Complete Resection in Patients with Primarily Unresectable Liver Tumors Compared with Conventional-Staged Hepatectomies: Results of a Multicenter Analysis

  • Erik Schadde
  • Victoria Ardiles
  • Ksenija Slankamenac
  • Christoph Tschuor
  • Gregory Sergeant
  • Nadja Amacker
  • Janine Baumgart
  • Kris Croome
  • Roberto Hernandez-Alejandro
  • Hauke Lang
  • Eduardo de Santibaňes
  • Pierre-Alain ClavienEmail author



Portal vein occlusion to increase the size of the future liver remnant (FLR) is well established, using portal vein ligation (PVL) or embolization (PVE) followed by resection 4–8 weeks later. Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) combines PVL and complete parenchymal transection, followed by hepatectomy within 1–2 weeks. ALPPS has been recently introduced but remains controversial. We compare the ability of ALPPS versus PVE or PVL for complete tumor resection.


A retrospective review of all patients undergoing ALPPS or conventional staged hepatectomies using PVL or PVE at four high-volume HPB centres between 2003 and 2012 was performed. Patients with primary liver tumors and liver metastases were included. Primary endpoint was complete tumor resection. Secondary endpoints include 90-day mortality, complications, FLR increase, time to resection, and tumor recurrence.


Forty-eight patients with ALPPS were compared with 83 patients with conventional-staged hepatectomies. Eighty-three percent (40/48 patients) of ALPPS patients achieved complete resection compared with 66 % (55/83 patients) in PVE/PVL (odds ratio 3.34, p = 0.027). Ninety-day mortality in ALPPS and PVE/PVL was 15 and 6 %, respectively (p = 0.2). Extrapolated growth rate was 11 times higher in ALPPS (34.8 cc/day; interquartile range (IQR) 26–49) compared with PVE/PVL (3 cc/day; IQR2-6; p = 0.001). Tumor recurrence at 1 year was 54 versus 52 % for ALPPS and PVE/PVL, respectively (p = 0.7).


This study provides evidence that ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors at the cost of a high mortality. The technique is promising but should currently not be used outside of studies and registries.


Portal Vein Embolization Future Liver Remnant Parenchymal Transection Complete Tumor Resection Postoperative Liver Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by the University of Zurich (Klinischer Forschungsschwerpunkt: Non-resectable Liver Tumors) and the Liver and Gastro-intestinal Disease Foundation (LGID) Swiss HPB Center, Zurich. We thank Sabine Kern, RN,  and Lisette Paratore for their help in data collection for this manuscipt.


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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Erik Schadde
    • 1
  • Victoria Ardiles
    • 2
  • Ksenija Slankamenac
    • 1
  • Christoph Tschuor
    • 1
  • Gregory Sergeant
    • 1
  • Nadja Amacker
    • 3
  • Janine Baumgart
    • 4
  • Kris Croome
    • 5
  • Roberto Hernandez-Alejandro
    • 5
  • Hauke Lang
    • 4
  • Eduardo de Santibaňes
    • 2
  • Pierre-Alain Clavien
    • 1
    Email author
  1. 1.Department of Surgery and Transplantation, Swiss HPB CenterUniversity Hospital ZurichZurichSwitzerland
  2. 2.Division of HPB Surgery and Liver Transplant Unit, Department of SurgeryItalian HospitalBuenos AiresArgentina
  3. 3.Department of RadiologyUniversity Hospital ZurichZurichSwitzerland
  4. 4.Department of Visceral Surgery and TransplantationUniversity of MainzMainzGermany
  5. 5.Division of HPB Surgery, Department of SurgeryWestern UniversityLondonCanada

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