Acute kidney injury after associating liver partition and portal vein ligation for staged hepatectomy for hepatocellular carcinoma: two case reports and a literature review

In 2012, Schnitzbauer et al. (1) formally introduced a new surgical strategy for patients with an insufficient future liver remnant (FLR) after major hepatectomy, which termed ALPPS (associating liver partition and portal vein ligation for staged hepatectomy). This technique involves ligation of the portal vein and a complete split of the liver parenchyma, which can considerably accelerate FLR hypertrophy and drastically reduce the time interval between stages. However, the surgery-related morbidity and mortality rates are relatively high (2). Until now, there is few reports about ALPPS applied in hepatocellular carcinoma with liver cirrhosis. Because the FLR compensatory hypertrophy maybe slower in cirrhosis liver, and increase the morbidity and mortality. A published analysis of the international ALPPS registry, which includes 202 patients, revealed an in-hospital mortality rate of 9% and a severe complication (grade ≥3b) (3) rate of 28% (4). It also shows the cases are mostly colorectal cancer liver metastasis (CRLM) patients, with a small part of hepatocellular carcinoma with liver cirrhosis (4). Although it may more risky to perform ALPPS in cirrhosis liver, there are reports indicated that ALPPS can be safely and effectively applied in hepatocellular carcinoma cases (5,6). But the associated morbidity and mortality rates were not reported in detail