• Marcelo Enne, Erik Schadde, Bergthór Björnsson, Hernandez Alejandro Roberto R Department of Surgery, University of Rochester, Rochester, NY, USA., Klaus Steinbruck, Eduardo Viana, Robles Campos Ricardo R Virgen de la Arrixaca University Hospital, Spain., Massimo Malago, Pierre-Alain Clavien, Eduardo De Santibanes, Brice Gayet, and ALPPS Registry Group.
• Ipanema Federal Hospital, Brazil. Electronic address: marceloenne@gmail.com.
• HPB (Oxford). 2017 Dec 1; 19 (12): 1126-1129.

BackgroundA minimum future liver remnant (FLR) of 30% is required to avoid post hepatectomy liver failure (PHLF). Portal vein occlusion (PVO) is the main strategy to induce hypertrophy of the FLR, but some patients will not reach sufficient FLR hypertrophy to enable resection. Recently ALPPS has emerged as a "Salvage Procedure" for PVO failure. The aim of this study was to report the short term outcomes of ALPPS following PVO failure.MethodsA retrospective analysis of patients enrolled within the international ALPPS Registry between October 2012 and November 2015 (NCT01924741) was performed. Patients with documented PVO failure were included. The outcomes reported included feasibility, FLR growth rate and safety of ALPPS. Complications were recorded as per Clavien-Dindo classification.ResultsFrom 510 patients enrolled in the Registry there were 22 patients with previous PVO failure. Two patients were excluded due to missing data and twenty patients were analysed. All of them completed the proposed ALPPS with a medium FLR increase of 88% (23-115%) between two stages and no 90-day mortality.ConclusionIn experienced centers, ALPPS following PVO failure is feasible and safe. The FLR hypertrophy was similar to other ALPPS series. ALPPS is a potential rescue strategy after PVO failure.Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

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