title: The ALPPS procedure as a novel "liver-first" approach in treating liver metastases of colon cancer: the first experience in Greek Cypriot area.
abstract: BACKGROUND
  Despite recent advances in multimodality and multidisciplinary treatment of colorectal liver metastases, many patients suffer from extensive bilobar disease, which prevents the performance of a single procedure due to an insufficient future liver remnant (FLR). We present a novel indication for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as a "liver-first" approach when inadequate FLR was faced preoperatively, in a patient with extensive bilobar liver metastatic disease of colon cancer origin.
  
  
  METHODS
  A 51-year-old lady was referred to our center due to a stage IV colon cancer with extensive bilobar liver disease and synchronous colon obstruction. During the multidisciplinary tumor board, it was recommended to proceed first in a palliative loop colostomy (at the level of transverse colon) operation and afterwards to offer her palliative chemotherapy. After seven cycles of chemotherapy, the patient was re-evaluated by CT scans that revealed an excellent response (>30%), but the metastatic liver disease was still considered inoperable. Moreover, with the completion of 12 cycles, the indicated restaging process showed further response. Subsequent to a thorough review by the multidisciplinary team, it was decided to proceed to the ALPPS procedure as a feasible means to perform extensive or bilobar liver resections, combined with a decreased risk of tumor progression in the interim.
  
  
  CONCLUSIONS
  All in all, ALPPS can offer a feasible but surgically demanding liver-first approach with satisfactory short-term results in selected patients. Larger studies are mandatory to evaluate short- and long-term results of the procedure on survival, morbidity, and mortality.
authors.affiliation: Nicosia Surgical Department, Division of Hepatobiliary Pancreatic Surgery, Nicosia General Hospital, Nicosia, Cyprus.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Petrou
authors.affiliation: 1st Department of Surgery, Medical School, Laikon General Hospital, University of Athens, Athens, Greece. dimmoris@yahoo.com.|Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. dimmoris@yahoo.com.|, Anastasiou Gennadiou 56, 11474, Athens, Greece. dimmoris@yahoo.com.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Moris
authors.affiliation: Bank of Cyprus Oncology Center, Nicosia, Cyprus.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Kountourakis
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Fard-Aghaie
authors.affiliation: Nicosia Surgical Department, Division of Hepatobiliary Pancreatic Surgery, Nicosia General Hospital, Nicosia, Cyprus.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Neofytou
authors.affiliation: 1st Department of Surgery, Medical School, Laikon General Hospital, University of Athens, Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Felekouras
authors.affiliation: 1st Department of Surgery, Medical School, Laikon General Hospital, University of Athens, Athens, Greece.|Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Papalampros
mesh_terms: D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006115:Greece; D006498:Hepatectomy; D006801:Humans; D008026:Ligation; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D014656:Vascular Surgical Procedures