Associating Liver Partition with Portal Vein Ligation and Staged Hepatectomy (ALPPS): Feasibility of Performing in Infants with Large Hepatic Tumor—Case Report

Abstract

Background: Surgical resection remains an important treatment of choice for a large number of liver tumors in children. Sometimes, if a tumor infiltrates a large part of the liver, after resection, the future liver remnant (FLR) is not enough for normal liver function. The size of the FLR is one of the determining factors for resectability as postoperative liver failure (PLF) is the most severe complication after partial hepatectomy. A new strategy for treating marginally resectable liver tumors in adult patients which were initially considered as unresectable was formally reported in 2011. This operative technique is a hepatectomy consisting of two stages with initial portal vein ligation and in situ splitting of the liver parenchyma. In 2012, the acronym “ALPPS” (associating liver partition and portal vein ligation for staged hepatectomy) was proposed for this novel technique. However, there is a small number of ALPPS procedures performed in pediatric patients published in the literature. Objectives: The aim of this paper is to present the first case of a pediatric patient with a marginally resectable rhabdoid tumor of the liver which was initially considered unresectable and who was treated with two-stage hepatectomy. We report a case of a 4-month-old girl with a large rhabdoid tumor of the liver who underwent this procedure. Conclusions: ALPPS can be a valuable technique to achieve complete resection of pediatric liver tumors although indications for ALPPS in children still need further research mainly focused on validation of the minimally needed FLR in children undergoing extended liver resections. To our knowledge, this is the youngest patient on whom ALPPS was performed, and the only one with a rhabdoid tumor. © 2025 by the authors.