Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.10208
Revised: March 8, 2014
Accepted: April 15, 2014
Published online: August 7, 2014
An insufficient future liver remnant (FLR) is associated with post-hepatectomy liver failure. Associating liver partition and portal vein ligation for stage hepatectomy (ALPPS) has been shown to be effective for the induction of rapid FLR hypertrophy so as to improve the resectability in patients with insufficient FLR. We hereby report our experience of this novel approach for a 6-year-old patient with hepatoblastoma. Computed tomography showed a hepatoblastoma measuring 12.5 cm × 9.9 cm × 11.7 cm in the right liver (Couinaud segment IV, V and VIII). Volumetric assessment of the FLR i.e., left lateral section was 112.6 mL i.e., 21.2% of the estimated total liver volume. In view of the small-for-size FLR, ALPPS was contemplated. An anterior approach was adopted for the in-situ parenchymal split without mobilisation of the right liver. FLR volumetry on the seventh postoperative day was 160.7 mL, which represented a 46.1% gain in volume, and a FLR/ESLV ratio of 30.2%. A right trisectionectomy was performed on the eighth postoperative day. Postoperative recovery was uneventful. Patient was discharged on day 16 after the first operation. To our knowledge, this was the first report that showed the applicability of ALPPS to a paediatric patient.
Core tip: Associating liver partition and portal vein ligation for stage hepatectomy (ALPPS) is a novel surgical approach that was first reported in 2012. This surgical approach has revolutionized the management of patients with resectable liver tumors and inadequate future liver remnant volume. Nonetheless, the global preliminary experience is so far limited to the use in adult patients with small future liver remnant. With the favorable outcome in adult patients reported so far, we have adopted this technique to a young patient with a right liver hepatoblastoma and small left lateral section. To our knowledge, this is the first report that showed the feasibility of ALPPS in a pediatric patient.