title: Associating Liver Partition and Portal Vein Ligation for Primary Hepatobiliary Malignancies and Non-Colorectal Liver Metastases.
abstract: OBJECTIVE
  Associating liver partition and portal vein ligation for staged hepatectomy may increase the possibility of radical resection in the case of liver malignancy. Concerns have been raised about the high morbidity and mortality associated with the procedure, particularly when applied for diagnoses other than colorectal liver metastases. The aim of this study was to analyze the initial experience with associating liver partition and portal vein ligation for staged hepatectomy in cases of non-colorectal liver metastases and primary hepatobiliary malignancies in Scandinavia.
  
  
  METHODS
  A retrospective analysis of all associating liver partition and portal vein ligation for staged hepatectomy procedures performed at two Swedish university hospitals for non-colorectal liver metastases and primary hepatobiliary malignancies was performed. The primary focus was on the safety of the procedure.
  
  
  CONCLUSIONS
  Ten patients were included: four had hepatocellular cancer, three had intrahepatic cholangiocarcinoma, one had a Klatskin tumor, one had ocular melanoma metastasis, and one had a metastasis from a Wilms' tumor. All patients completed both operations, and the highest grade of complication (according to the Clavien-Dindo classification) was 3A, which was observed in one patient. No 90-day mortality was observed. Radical resection (R0) was achieved in nine patients, while the resection was R2 in one patient. The low morbidity and mortality observed in this cohort compared with those of earlier reports on associating liver partition and portal vein ligation for staged hepatectomy for diagnoses other than colorectal liver metastases may be related to the selection of patients with limited comorbidity. In addition, procedures other than associating liver partition and portal vein ligation for staged hepatectomy had been avoided in most of the patients. In conclusion, associating liver partition and portal vein ligation for staged hepatectomy can be applied to primary hepatobiliary malignancies and non-colorectal liver metastases with acceptable rates of morbidity and mortality.
authors.affiliation: Department of Surgery, Linköping University Hospital, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden bergthor.bjornsson@liu.se.
authors.forename: B
authors.initials: B
authors.lastname: Björnsson
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Sparrelid
authors.affiliation: Department of Surgery, Linköping University Hospital, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Hasselgren
authors.affiliation: Department of Surgery, Linköping University Hospital, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Gasslander
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Isaksson
authors.affiliation: Department of Surgery, Linköping University Hospital, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Sandström
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D018281:Cholangiocarcinoma / Q000601:surgery; D005134:Eye Neoplasms / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D018285:Klatskin Tumor / Q000601:surgery; D008026:Ligation; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D061214:Patient Safety; D011169:Portal Vein / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000556:secondary / Q000601:surgery
keywords: Liver; associating liver partition and portal vein ligation for staged hepatectomy; future liver remnant; hepatocellular cancer; intrahepatic cholangiocarcinoma; liver resection; non-colorectal liver metastases; perihilar cholangiocarcinoma