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Malerba et al. Hepatoma Res 2021;7:19 Hepatoma Research
DOI: 10.20517/2394-5079.2020.131

Case Report Open Access

From PVE to HVE to fully laparoscopic rescue
ALPPS: a case report of multidisciplinary

management of giant HCC

Valentina Malerba , Andrea Benedetti Cacciaguerra , Giuseppe Zimmitti , Alberto Manzoni , Claudio
1
1
1
1
Sallemi , Lorenzo Monfardini , Massimo Graffeo , Claudio Bnà , Giuseppe Natalini , Alberto Zaniboni ,
5
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2
2
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Maria Cristina Montresor , Claudio Codignola , Marco Garatti , Mohammed Abu Hilal 1
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1 Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia 25124, Italy.
2 Department of Radiology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia 25124, Italy.
3 Department of Internal Medicine, Gastroenterology and Endoscopy, Istituto Ospedaliero Fondazione Poliambulanza, Brescia
25124, Italy.
4 Department of Anesthesia and Intensive Care, Istituto Ospedaliero Fondazione Poliambulanza, Brescia 25124, Italy.
5 Department of Oncology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia 25124, Italy.
6 Department of Pathology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia 25124, Italy.
Correspondence to: Prof. Mohammed Abu Hilal, Department of Surgery, Poliambulanza Foundation Hospital Brescia, Via
Bissolati n 57, Brescia 25124, Italy. E-mail: abuhilal9@gmail.com
How to cite this article: Malerba V, Benedetti Cacciaguerra A, Zimmitti G, Manzoni A, Sallemi C, Monfardini L, Graffeo M, Bnà
C, Natalini G, Zaniboni A, Montresor MC, Codignola C, Garatti M, Abu Hilal M. From PVE to HVE to fully laparoscopic rescue
Received: First Decision: Revised: Accepted: Published: ALPPS: a case report of multidisciplinary management of giant HCC. Hepatoma Res 2021;7:19.
http://dx.doi.org/10.20517/2394-5079.2020.131
Science Editor: Copy Editor: Production Editor: Jing Yu
Received: 21 Oct 2020 First Decision: 14 Dec 2020 Revised: 3 Jan 2021 Accepted: 6 Jan 2021 Published: 9 Mar 2021
Academic Editor: Ho-Seong Han, Georgios Tsoulfas Copy Editor: Miao Zhang Production Editor: Jing Yu
Abstract
Different strategies have been used to induce preoperative liver hypertrophy and reduce the risk of postoperative
liver failure. Those have included both radiological-interventional and surgical strategies, such as portal and
hepatic vein embolization, 2-stage hepatectomy and associated liver partition with portal vein ligation for staged
hepatectomy (ALPPS). Herein, we describe the case of a patient with a large right liver hepatocellular carcinoma
not amenable to liver transplantation, with HBV-related chronic hepatitis and a small future liver remnant (FLR),
who underwent a multistep approach to ensure a safe major laparoscopic resection with an adequate FLR.

Keywords: Portal vein embolization, hepatic vein embolization, rescue ALPPS, laparoscopic surgery, hepatectomy,
hepatocellular carcinoma

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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