title: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity.
abstract: BACKGROUND
  We compared clinical outcomes of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) against those of classical 2-stage hepatectomy in treating metastatic liver disease.
  
  
  METHODS
  Short-term outcomes, serial changes in volume of the future liver remnant (FLR), functional FLR volume, and tumor growth activity during the treatment period, were compared between our first 11 consecutive patients treated with ALPPS and 54 patients treated with classical 2-stage hepatectomy.
  
  
  RESULTS
  Mortality in the ALPPS group (9%) tended to be higher than in the classical 2-stage group (2%, P = 0.341). The FLR hypertrophy ratio (FLR volume after vs. before the procedure) 1 week after the first operation in the ALPPS group (1.54 ± 0.18) exceeded that in the classical 2-stage group (1.19 ± 0.29, P = 0.005), being similar to the ratio at 3 weeks after the first procedure in the classical 2-stage group (1.40 ± 0.43). However, functional volume of the FLR in the ALPPS group 1 week after the first procedure (52.1%) tended to be smaller than that in the classical group 3 weeks after the first procedure (59.2%).
  
  
  CONCLUSIONS
  ALPPS should be used with extreme caution, giving special attention to postoperative complications and grade of functional liver regeneration.
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan. Electronic address: U17-92TS@med.teikyo-u.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: D
authors.initials: D
authors.lastname: Kawaguchi
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Hiroshima
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Koda
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Endo
authors.affiliation: Department of Clinical Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ichikawa
authors.affiliation: Department of Biostatistics and Epidemiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Taguri
authors.affiliation: Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tanabe
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D006984:Hypertrophy / Q000209:etiology; D019394:Ki-67 Antigen / Q000032:analysis; D008026:Ligation; D008099:Liver / Q000473:pathology* / Q000503:physiopathology; D008113:Liver Neoplasms / Q000737:chemistry / Q000556:secondary / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011169:Portal Vein; D020127:Recovery of Function; D047368:Tumor Burden
chemical_list: D019394:Ki-67 Antigen
keywords: ALPPS; Colorectal cancer; Liver metastases; Staged hepatectomy