The combination of extra-Glissonian pedicle ligation of the tumor-bearing area and traditional ALPPS: a novel modified ALPPS method.

Abstract

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can provide patients with large liver tumors the opportunity to undergo radical resection. However, tumor progression between the surgical stages and unsatisfactory hyperplasia of the residual liver reduces the second-stage resection rate and limit the application of ALPPS. We reported a novel modified ALPPS method that can accelerate tumor necrosis and hyperplasia of the residual liver and increase the second-stage resection rate. The data of patients who underwent the novel modified ALPPS procedure in our hospital between September 2021 and April 2024 were retrospectively analyzed. In addition to ligation of the right hepatic portal vein and liver partition during the first stage, we transected all the Glissonian pedicles of the tumor-bearing area to accelerate tumor necrosis. Ultimately, three patients underwent this novel modified ALPPS procedure. Second-stage resection was successfully performed in all these patients. Satisfactory hyperplasia was obtained in the residual liver before the second stage of surgery. The tumor-bearing area showed obvious necrosis and atrophy. The residual liver volumes of the three patients increased by 83%, 23%, and 49%, respectively. No postoperative complications or tumor recurrence was observed. This novel modified approach is safe and effective. This approach can prevent tumor progression between the surgical stages and promote compensatory liver proliferation.