title: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in colorectal liver metastasis: the radiologist's perspective.
abstract: Hepatic resection is the only potentially curative treatment for patients with colorectal liver metastasis (CRLM). Many multidisciplinary approaches, including the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure, have been proposed to increase the resectability rate in these patients. ALPPS is the most recently described staged liver resection technique, representing an advantageous strategy to induce a rapid and marked increase in the future liver remnant (FLR) volume. The aim of this article is to describe the radiological evaluation of this procedure and its variation.
  
  
  
  This retrospective study included 9 patients with CRLM who underwent the ALPPS procedure. Abdominal imaging studies were reviewed, with an emphasis on a rational radiological approach. The number of liver metastases, the FLR volume (pre- and postportal vein ligation), anatomical variations, potential pitfalls related to disease progression, and postoperative complications were evaluated.
  
  
  
  The types of hepatic resection included 4 classical ALPPS cases, 3 right ALPPS variations, and 2 left ALPPS variations. The mean FLR volume calculated in the initial evaluation was 453 mL (213-790 mL). Following the first surgery, the mean FLR volume increased to 634 mL (410-957 mL), which indicated a mean volume increase of 181.1 mL (95% CI 149.7-212.5 mL; p < 0.001) and a mean absolute volume increase of 48% (19%-88%).
  
  
  
  The ALPPS procedure is an emerging form of two-stage hepatectomy. In this context, radiologists should provide crucial preoperative and perioperative information that may change surgical planning and contribute to an improvement in the oncologic outcome.
authors.affiliation: Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, 01308-050, Brazil.
authors.forename: L C
authors.initials: LC
authors.lastname: Zattar-Ramos
authors.affiliation: Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, 01308-050, Brazil. regisfranca@gmail.com.|Cancer Institute of the State of São Paulo and Department of Radiology and Oncology, Medical School, University of São Paulo , São Paulo, Brazil. regisfranca@gmail.com.
authors.forename: R O
authors.initials: RO
authors.lastname: Bezerra
authors.affiliation: Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, 01308-050, Brazil.
authors.forename: L T
authors.initials: LT
authors.lastname: Siqueira
authors.affiliation: Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, 01308-050, Brazil.
authors.forename: D T
authors.initials: DT
authors.lastname: Marques
authors.affiliation: Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, 01308-050, Brazil.|Cancer Institute of the State of São Paulo and Department of Radiology and Oncology, Medical School, University of São Paulo , São Paulo, Brazil.
authors.forename: M R
authors.initials: MR
authors.lastname: Menezes
authors.affiliation: Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, 01308-050, Brazil.|Department of Gastroenterology, Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: P
authors.initials: P
authors.lastname: Herman
authors.affiliation: Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, 01308-050, Brazil.
authors.forename: M A C
authors.initials: MA
authors.lastname: Machado
authors.affiliation: Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, 01308-050, Brazil.|Cancer Institute of the State of São Paulo and Department of Radiology and Oncology, Medical School, University of São Paulo , São Paulo, Brazil.
authors.forename: G G
authors.initials: GG
authors.lastname: Cerri
authors.affiliation: Hospital Sírio-Libanês, Rua Dona Adma Jafet 91, São Paulo, 01308-050, Brazil.|Cancer Institute of the State of São Paulo and Department of Radiology and Oncology, Medical School, University of São Paulo , São Paulo, Brazil.
authors.forename: C C
authors.initials: CC
authors.lastname: Leite
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008026:Ligation; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hepatectomy; Magnetic resonance imaging; Metastases; Surgical technique; Tomography