Portal Vein Embolization versus Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy

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Abstract

Background/Aims: Liver failure after extended hepatic resection is an obstacle that must be overcome by hepatobiliary surgeons. Portal vein embolization (PVE) played an important role in dealing with this issue since the last 30 years. Recently, a new strategy known as “Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)” has been developed. To clarify the advantage and disadvantage of ALPPS, we reviewed the published articles. Methods: A web search was performed in “PubMED” databases to identify the articles published that were related to this topic. Based on the results, a comparative investigation was carried out. Results: The reported advantages of ALPPS are: rapid liver hypertrophy and a remarkably high resectability rate. The hypertrophy rate in PVE and ALPPS is 10–80 and 47–160%. The disadvantages of ALPPS compared to PVE are high morbidity and mortality rates. The morbidity rates for PVE and ALLPS are 8–49 and 12–100%, respectively, and the mortality rates for PVE and ALPPS are 0–8.8 and 0–28.7%, respectively. Due to the short history of ALPPS, details of the mechanism underlying ALPPS have not yet been fully clarified and a suitable indication for the practice of ALPPS is currently under debate. Conclusion: It is imperative that the issue of a high mortality rate following ALPPS is immediately resolved before ALPPS can be widely accepted. In addition, comparison studies between PVE and ALPPS must be conducted to elicit proper and appropriate applications of PVE and ALPPS.

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