TY - JOUR
AR - IJSCR-2019-1-106
TI - Surgical Removal of Inadvertent Portal Thrombosis by Rescue-ALPPS for Perihilar Cholangiocarcinoma
AU - Jens , Rolinger
AU - Jun, Li
JO - International Journal of Surgical Case Reports
PY - 2019
DA - Tue 16, Jul 2019
SN - 2674-4171
DO - http://dx.doi.org/10.31487/j.IJSCR.2019.01.06
UR - https://www.sciencerepository.org/surgical-removal-of-inadvertent-portal-thrombosis-by-rescue-alpps-for-perihilar-cholangiocarcinoma_IJSCR-2019-1-106 
KW - Case report, rescue-ALPPS, portal vein embolization, perihilar cholangiocarcinoma
AB - Introduction: Treatment of perihilar cholangiocarcinoma (PHC) usually requires extended resection after inducing hypertrophy of the future liver remnant (FLR). Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can achieve rapid hypertrophy of the FLR. Though, due to significant morbidity and mortality, portal vein embolization (PVE) is considered gold standard. Despite remaining controversies, ALPPS might suit as reserve in patients who failed to achieve adequate hypertrophy of the FLR or suffered complications following PVE. We illustrate a rescue-ALPPS after inadvertent nontarget thrombosis of the FLR following PVE in a patient with PHC. 
Presentation of Case: A 67-year-old patient requiring right trisectionectomy for PHC Bismuth type IV suffered inadvertent nontarget portal thrombosis of the FLR following PVE. Subsequently, insufficient FLR hypertrophy prevented the planned surgical resection. ALPPS procedure with concomitant thrombectomy of the left portal vein was used as a rescue strategy for this patient.
Discussion: Since ALPPS is associated with significant limitations, especially in patients with PHC, this approach remains controversial. However, surgery still remains the only curative option for patients with PHC and thus, in case of inadequate hypertrophy of the FLR or technical failure following PVE, these patients lack further treatment options. Recent technical refinements and methods of improved patient selection have the potential to emend outcomes of ALPPS in experienced centres.
Conclusion: ALPPS should be considered as reasonable rescue strategy not only in case of insufficient hypertrophy of the FLR but also in the event of technical failure or complications following PVE, even in patients with PHC.