title: Rescue ALPPS is efficient and safe after failed portal vein occlusion in patients with colorectal liver metastases.
abstract: OBJECTIVE
  The aim of this study was to investigate whether associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can be used as an effective and safe rescue procedure in patients with colorectal liver metastases (CRLM) and insufficient effect on the future liver remnant (FLR) after previous portal vein occlusion (PVO).
  
  
  METHODS
  Eleven patients with bilobar CRLM treated with neoadjuvant chemotherapy and previous PVO with insufficient effect on the FLR were analyzed retrospectively from a prospective database. FLR was evaluated with computed tomography volumetry 6 days after stage 1, and stage 2 was performed on day seven.
  
  
  RESULTS
  Six days after stage 1, the median increase of the FLR was 209 ml (range 87-314, P < 0.001). This corresponded to a median FLR growth of 61.8 % (range 19.3-120) resulting in an FLR/BW ratio >0.5 % in all patients and successful subsequent removal of the tumor bearing liver (segments IV-VIII) in all patients with no 90-day mortality. No patient had a 3b-complication or more according to Clavien-Dindo. No patient developed severe posthepatectomy liver failure.
  
  
  CONCLUSIONS
  The powerful hypertrophy of the FLR associated with ALPPS seems to be maintained in patients with CRLM and previous failed PVO.
authors.affiliation: Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. ernesto.sparrelid@ki.se.|Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. ernesto.sparrelid@ki.se.
authors.forename: Ernesto
authors.identifier: http://orcid.org/0000-0003-0259-8328
authors.initials: E
authors.lastname: Sparrelid
authors.affiliation: Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Gilg
authors.affiliation: Division of Radiology, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Torkel B
authors.initials: TB
authors.lastname: Brismar
authors.affiliation: Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.affiliation: Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Isaksson
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008026:Ligation; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure
keywords: ALPPS; Colorectal liver metastases; Liver resection; PVO