Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was founded in 2007 by Professor Han J. Schlitt from Germany [1]. The ALPPS procedure was originally called “right portal vein ligation combined with in situ splitting.” In 2012, Professors Andreas A. Schnitzbauer and Hans J. Schlitt summarized the early experience results and reported in the Annals of Surgery [2]. Professor de Santibañes E and Professor Pierre-Alain Clavien officially named the novel procedure “associating liver partition and portal vein ligation for staged hepatectomy” and abbreviated it as ALPPS [3]. This technique was initially associated with high perioperative complications and 90-day mortality (68% and 12%), rendering its safety controversial [2]. Subsequently, the ALPPS procedure was improved to reduce the undesirable results and increase surgical safety, giving birth to “classical ALPPS” [4–6]. On this basis, many hepatobiliary surgeons have applied various methods, making progress in multiple aspects, including surgical approach (minimally invasive/anterior approach), liver parenchymal separation methods (partial partition instead of complete separation, radiofrequency/microwave ablation and tourniquet separation instead of liver partition), and portal vein embolization (PVE) instead of PVL. These have further minimized the complication and mortality rates and optimized safety. Numerous modified ALPPS have been developed, including laparoscopic/robot-assisted ALPPS, partial ALPPS, radiofrequency ablation (RFA)/microwave ablation (MWA)-assisted ALPPS, tourniquet ALPPS, and hybrid ALPPS [4, 6, 7]. By 2015, the use of modified ALPPS procedures accounted for 52% of all ALPPS cases [6]. In addition, applications become more flexible regardless of tumor site, FLR location, and resection range. Right trisectionectomy in classical ALPPS is expanded to extended right/left hepatectomy, right/left hemihepatectomy, and mesohepatectomy [8–12]. The required number of liver segments is no longer limited to two, and single-segment ALPPS (monosegment ALPPS) has also been successfully performed [13, 14]. With the emergence of these modifications, “classical ALPPS” has become a relative concept. Meanwhile, it has been coupled with considerable improvements compared to the original procedure. Measures to ameliorate common postoperative complications (such as bile leakage) have been integrated and have become essential elements. For example, wrapping the liver with plastic bags and ligating the right bile duct have been abandoned, and strict bile leakage checks are routinely implemented. Tumor location and resection range are no longer limited to right trisectionectomy but expanded to extended right hemihepatectomy and right hemihepatectomy, and the right / extended right hemihepatectomy ALPPS have accounted for a more significant proportion in clinical practices.

Classical ALPPS

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发表日期：

2025年

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Yuanfei Peng

摘要

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was founded in 2007 by Professor Han J. Schlitt from Germany [1]. The ALPPS procedure was originally called “right portal vein ligation combined with in situ splitting.” In 2012, Professors Andreas A. Schnitzbauer and Hans J. Schlitt summarized the early experience results and reported in the Annals of Surgery [2]. Professor de Santibañes E and Professor Pierre-Alain Clavien officially named the novel procedure “associating liver partition and portal vein ligation for staged hepatectomy” and abbreviated it as ALPPS [3]. This technique was initially associated with high perioperative complications and 90-day mortality (68% and 12%), rendering its safety controversial [2]. Subsequently, the ALPPS procedure was improved to reduce the undesirable results and increase surgical safety, giving birth to “classical ALPPS” [4–6]. On this basis, many hepatobiliary surgeons have applied various methods, making progress in multiple aspects, including surgical approach (minimally invasive/anterior approach), liver parenchymal separation methods (partial partition instead of complete separation, radiofrequency/microwave ablation and tourniquet separation instead of liver partition), and portal vein embolization (PVE) instead of PVL. These have further minimized the complication and mortality rates and optimized safety. Numerous modified ALPPS have been developed, including laparoscopic/robot-assisted ALPPS, partial ALPPS, radiofrequency ablation (RFA)/microwave ablation (MWA)-assisted ALPPS, tourniquet ALPPS, and hybrid ALPPS [4, 6, 7]. By 2015, the use of modified ALPPS procedures accounted for 52% of all ALPPS cases [6]. In addition, applications become more flexible regardless of tumor site, FLR location, and resection range. Right trisectionectomy in classical ALPPS is expanded to extended right/left hepatectomy, right/left hemihepatectomy, and mesohepatectomy [8–12]. The required number of liver segments is no longer limited to two, and single-segment ALPPS (monosegment ALPPS) has also been successfully performed [13, 14]. With the emergence of these modifications, “classical ALPPS” has become a relative concept. Meanwhile, it has been coupled with considerable improvements compared to the original procedure. Measures to ameliorate common postoperative complications (such as bile leakage) have been integrated and have become essential elements. For example, wrapping the liver with plastic bags and ligating the right bile duct have been abandoned, and strict bile leakage checks are routinely implemented. Tumor location and resection range are no longer limited to right trisectionectomy but expanded to extended right hemihepatectomy and right hemihepatectomy, and the right / extended right hemihepatectomy ALPPS have accounted for a more significant proportion in clinical practices.