ALPPS liver resection: a patient guide

During the initial operation, surgeons redirect blood flow and divide liver tissue to encourage the future liver remnant to grow. Imaging and blood tests then assess recovery and growth before the planned operation that removes the diseased portion.

The name stands for associating liver partition and portal vein ligation for staged hepatectomy. It may be considered for some primary liver tumours or liver metastases when standard resection would leave inadequate functioning liver. Suitability depends on tumour position, blood-vessel involvement, liver health, general fitness and whether disease is controlled outside the liver.

ALPPS is a major, complex pathway rather than a routine form of liver surgery. The team weighs it against other approaches, which may include a different staged resection, portal-vein procedures, systemic treatment or tumour ablation. Reaching the next operation depends on the liver remnant functioning and growing adequately and on the absence of a new reason to stop.

Before surgery, provide a complete medicines list, including supplements and blood-thinning medicines, and follow the hospital's instructions about eating, drinking and medication changes. Tests commonly evaluate liver function, remaining-liver volume, heart and lung fitness, and the tumour's relationship to major vessels.

After each operation, the team monitors pain, breathing, wounds, liver blood tests, fluid balance and signs of infection or bile leakage. Walking with assistance, breathing exercises and the prescribed nutrition plan support recovery. Do not lift, drive or restart withheld medicines until the surgical team says it is appropriate.

Contact the liver surgery team urgently for fever, increasing abdominal pain, a swollen abdomen, yellow skin or eyes, repeated vomiting, confusion, wound discharge, or inability to eat or drink. Call emergency services for severe breathlessness, chest pain, fainting, heavy bleeding, or sudden collapse. Follow the discharge number and instructions given by your own hospital because complications between the staged operations require prompt assessment.

Ask why ALPPS is being recommended over another liver procedure, how much healthy liver is expected to remain, what would prevent the later operation, how long you may remain in hospital, and who to contact between stages. It is also reasonable to ask whether your case has been reviewed by a multidisciplinary liver tumour team.