Dr. Vibha Verma: ALPPS – Hope in a situation of Despair

    A 45 year old male patient presented to Dr Vibha Varma with a diagnosis of liver cancer and he was told that he had inoperable disease and that nothing could be done. He presented with history of weakness and loss of appetite of one month duration. He came for second opinion to Kokilaben Dhirubhai Ambani Hospital, HPB and Liver transplant department. His CT scan was reviewed and it showed a large tumour occupying the whole of right lobe of liver with some more lesions going to the medial segments of left lobe. He was found to have hepatitis C virus infection however his liver function tests were within normal limits. For a cure he would have required removal of right lobe of liver along with a portion of the left lobe which would leave him with a very small remnant liver and this would risk him of having liver failure in the postoperative period. As he was young and otherwise fit, Dr Varma gave him the option of surgical treatment in the form of either liver transplantation or in the form of an innovative technique of staged liver resection.

    The family did not agree for liver transplantation hence he was left with the second best option of surgical cure in the form of staged hepatectomy otherwise known as ALPPS (Associating Liver Partition with Portal vein ligation and Staged hepatectomy) procedure. ALPPS is indicated in patients who present with massive tumour in the liver and where surgical treatment would leave behind a small remnant liver. This patient was evaluated and had the first stage of procedure wherein the liver was transected and blood supply was cut off to the portion which had to be removed and after a gap of 14 days a CT scan was performed which confirmed that the remnant liver had increased in size by 70%. He was again taken up for second stage procedure and the tumour could be successfully removed. He had a smooth recovery and was discharged home 7 days after second surgery. This ALPPS procedure is the first case to be registered from India https://www.alpps.net.  It is an option where so called inoperable/unresectable tumour of the liver can be operated and one can offer a new lease of life to these patients.