Laparoscopic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (L‑ALPPS) of Right Hemihepatectomy and Regional Lymph Node Dissection for Intrahepatic Cholangiocarcinoma (With Video).

Background: Although the application of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in intrahepatic cholangiocarcinoma (ICC) is still controversial, it continues to be attempted in selected patients. This video case discusses the key technical points for a complete laparoscopic ALPPS (L-ALPPS) of right hemihepatectomy and regional lymph node (LN) dissection for ICC.

Methods: A 61-year-old ICC patient received L-ALPPS for right hemihepatectomy and regional LN dissection. The patient was deemed suitable as he only had two intrahepatic metastases, all in the right half of the liver, and no LN metastasis. The standardized remnant liver volume ratio (SRLVR) was only 38.17%, and the indocyanine green retention at 15 min (ICG-R15) was 11.9%.

Results: The surgeries were carried out following the 'easy-first' and 'no-touch' principles. The operation time and bleeding volume were 300 min and 200 mL for stage I, respectively, and 140 min and 50 mL for stage II, respectively. For both stages, the patient was discharged 7 days after the surgery and had no postoperative complications. The histological grading of the tumor was T2N0M0. The patient received postoperative adjuvant chemotherapy, and all examinations showed no obvious abnormalities 5 months after surgery.

Conclusions: L‑ALPPS provides an opportunity for radical surgery to selected ICC patients who have initially insufficient SRLVR and are intolerant to extensive hepatectomy. For these patients, by adhering to standardized laparoscopic techniques, surgeons can safely perform L‑ALPPS and regional LN dissection at resourceful laparoscopic surgery institutions.