Case Report
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World J Gastroenterol. Aug 7, 2014; 20(29): 10208-10211
Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.10208
Little girl who conquered the "ALPPS''
Albert Chan, Patrick HY Chung, Ronnie TP Poon
Albert Chan, Ronnie TP Poon, Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
Patrick HY Chung, Division of Pediatric Surgery, Department of Surgery, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
Author contributions: Chan A, Chung PHY and Poon RTP contributed equally to this work; Chan A and Poon RTP designed the research; Chan A, Chung PHY and Poon RTP performed the research; Chan A and Chung PHY performed the data analysis; Chan A, Chung PHY and Poon RTP wrote the paper.
Correspondence to: Albert Chan, MBBS, FRCS, Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China. acchan@hku.hk
Telephone: +852-2-2553025 Fax: +852-2-8165284
Received: January 21, 2014
Revised: March 8, 2014
Accepted: April 15, 2014
Published online: August 7, 2014
Processing time: 197 Days and 21.4 Hours
Abstract

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.

Keywords: Associating liver partition and portal vein ligation for stage hepatectomy; Hepatectomy; Portal vein; Hepatoblastoma; In-situ split

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.