title: ALPPS and similar resection procedures in treating extensive hepatic metastases: our own experiences and critical discussion.
abstract: BACKGROUND
  The combination of right sided portal vein ligation and hepatic parenchymal transection thus inducing a hypertrophy of the left or left lateral sector is an innovative treatment option in treating locally advanced hepatic tumors or hepatic metastases. The available published data regarding this procedure is weak. We analyzed our own data regarding tumor recurrence and complications. The data was then used to be critically analyzed using the available published literature.
  
  
  METHODS
  We treated n = 5 patients with an ALPPS (associating liver partition and portal vein ligation for staged hepatectomy). The follow-up was 3 years. We analyzed the perioperative period, complications, mortality and oncological survival rate.
  
  
  RESULTS
  In all patients (n = 5) a R0-resection was achieved. N = 1 patient died postoperatively. N = 1 patient died 6 month later due to a pulmonary embolism. N = 3 patients had a tumor recurrence within 6 months.
  
  
  CONCLUSIONS
  Selected patients can be successfully treated by ALPPS in terms of an R0-resection. However, risk of tumor recurrence and rate of complications are high.
authors.affiliation: European Medical School Oldenburg, University Department for General and Visceral Surgery, Klinikum Oldenburg, Germany. Electronic address: troja.achim@klinikum-oldenburg.de.
authors.forename: Achim
authors.initials: A
authors.lastname: Troja
authors.affiliation: European Medical School Oldenburg, University Department for General and Visceral Surgery, Klinikum Oldenburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Khatib-Chahidi
authors.affiliation: European Medical School Oldenburg, University Department for General and Visceral Surgery, Klinikum Oldenburg, Germany.
authors.forename: Nader
authors.initials: N
authors.lastname: El-Sourani
authors.affiliation: European Medical School Oldenburg, University Department for General and Visceral Surgery, Klinikum Oldenburg, Germany.
authors.forename: Dalibor
authors.initials: D
authors.lastname: Antolovic
authors.affiliation: European Medical School Oldenburg, University Department for General and Visceral Surgery, Klinikum Oldenburg, Germany.
authors.forename: Hans-Rudolf
authors.initials: HR
authors.lastname: Raab
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D006984:Hypertrophy; D008026:Ligation; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000098:blood supply / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D018579:Patient Selection; D011169:Portal Vein; D015996:Survival Rate
keywords: ALPPS; In-situ split; Liver metastasis; Major liver resection