title: Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy.
abstract: BACKGROUND
  Liver remnant function limits major liver resections to generally leave patients with ≥2 Couinaud segments. Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) induces extensive hypertrophy and allows surgeons to perform extreme liver resections.
  
  
  METHODS
  The international ALPPS registry (NCT01924741; 2011-2014) was screened for novel resection type with only 1 segment remnant. The anatomy of lesions and indications for ALPPS, operative technique, complications, survival, and recurrence were evaluated.
  
  
  RESULTS
  Among 333 patients, 12 underwent monosegment ALPPS hepatectomies in 6 centers, all for extensive bilobar colorectal liver metastases. All patients were considered unresectable by conventional means, and all had a response to or no progression after chemotherapy before surgery. In 2 patients, the liver remnant consisted of segment 2, in 2 of segment 3, in 6 of segment 4, and in 2 of segment 6. Median time to proceed to stage 2 was 13 days and median hypertrophy of the liver remnant was 160%. There was no mortality. Four patients experienced liver failure, but all recovered. Complications higher than Dindo-Clavien IIIa occurred in 4 patients with no long-term sequelae. At a median follow-up of 14 months, 6 patients are tumor free and 6 patients have developed recurrent metastatic disease.
  
  
  CONCLUSIONS
  ALPPS allows systematic liver resections with monosegment remnants, a novelty in liver surgery. Because such resections are difficult to conceive without rapid hypertrophy, we propose to name such resections after the segments constituting the liver remnant rather than the segments removed.
authors.affiliation: Department of Surgery, and Institute of Physiology, Kantonsspital Winterthur, and University of Zurich, Zurich, Switzerland. Electronic address: erik.schadde@uzh.ch.
authors.forename: Erik
authors.initials: E
authors.lastname: Schadde
authors.affiliation: Department of HPB- and Liver Transplantation Surgery, University College London, Royal Free Hospitals, London, UK.
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
authors.affiliation: Department of Surgery, Division of HPB Surgery and Liver Transplantation, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernandez-Alejandro
authors.affiliation: Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Lebanese American University, Beirut, Lebanon.
authors.forename: Eddie
authors.initials: E
authors.lastname: Abdalla
authors.affiliation: HPB Surgery and Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina.
authors.forename: Victoria
authors.initials: V
authors.lastname: Ardiles
authors.affiliation: Department of HPB- and Liver Transplantation Surgery, University College London, Royal Free Hospitals, London, UK; Department of Surgery, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Lurje
authors.affiliation: Department of HPB- and Liver Transplantation Surgery, University College London, Royal Free Hospitals, London, UK.
authors.forename: Soumil
authors.initials: S
authors.lastname: Vyas
authors.affiliation: Sirio Libanes Hospital, University of Sao Paolo, Sao Paolo, Brazil.
authors.forename: Marcel A
authors.initials: MA
authors.lastname: Machado
authors.affiliation: HPB Surgery and Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006984:Hypertrophy; D008026:Ligation; D008099:Liver / Q000254:growth & development* / Q000473:pathology / Q000601:surgery; D017093:Liver Failure / Q000209:etiology; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome