Skip to main content
SpringerLink
Log in

Two-Stage Approach to Liver Resection

  • Chapter
  • First Online:
Primary and Metastatic Liver Tumors

  • 602 Accesses

Abstract

This chapter reviews the history, indications, and outcomes of two-stage hepatectomy, including both conventional two-stage resection and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). The underlying mechanisms of liver hypertrophy as they relate to two-stage resection and portal vein occlusion are explored.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bismuth H, Adam R, Lévi F, Farabos C, Waechter F, Castaing D, et al. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg. 1996;224:509–20.

    Article  CAS  Google Scholar 

  2. Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H. Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg. 2000;232:777–85.

    Article  CAS  Google Scholar 

  3. Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunvén P, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107:521–7.

    CAS  PubMed  Google Scholar 

  4. Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber J-C, Bachellier P. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg. 2004;240:1037–51.

    Article  Google Scholar 

  5. Jaeck D, Bachellier P, Guiguet M, Boudjema K, Vaillant JC, Balladur P, et al. Long-term survival following resection of colorectal hepatic metastases. Br J Surg. 1997;84:977–80.

    Article  CAS  Google Scholar 

  6. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18.

    Article  CAS  Google Scholar 

  7. Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Cancer. 1996;77:1254–62.

    Article  CAS  Google Scholar 

  8. Kishi Y, Abdalla EK, Chun YS, Zorzi D, Madoff DC, Wallace MJ, et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg. 2009;127:171–9.

    Google Scholar 

  9. Shindoh J, Tzeng C-WD, Aloia TA, Curley SA, Zimmitti G, Wei SH, et al. Optimal future liver remnant in patients treated with extensive preoperative chemotherapy for colorectal liver metastases. Ann Surg Oncol. 2013;20:2493–500.

    Article  Google Scholar 

  10. Shoup M, Gonen M, D’Angelica M, Jarnagin WR, DeMatteo RP, Schwartz LH, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg. 2003;7:325–30.

    Article  Google Scholar 

  11. Pozzo C, Basso M, Cassano A, Quirino M, Schinzari G, Trigila N, et al. Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol. 2004;15:933–9.

    Article  CAS  Google Scholar 

  12. Alberts SR. Oxaliplatin, fluorouracil, and leucovorin for patients with unresectable liver-only metastases from colorectal cancer: a North Central Cancer Treatment Group Phase II Study. J Clin Oncol. 2005;23:9243–9.

    Article  CAS  Google Scholar 

  13. Ho WM, Ma B, Mok T, Yeo W, Lai P, Lim R, et al. Liver resection after irinotecan, 5-fluorouracil, and folinic acid for patients with unresectable colorectal liver metastases: a multicenter phase II study by the Cancer Therapeutic Research Group. Med Oncol. 2005;22:303–12.

    Article  CAS  Google Scholar 

  14. Elias D, Baton O, Sideris L, Boige V, Malka D, Liberale G, et al. Hepatectomy plus intraoperative radiofrequency ablation and chemotherapy to treat technically unresectable multiple colorectal liver metastases. J Surg Oncol. 2005;90:36–42.

    Article  Google Scholar 

  15. Michalopoulos GK, DeFrances MC. Liver regeneration. Science. 1997;276:60–6.

    Article  CAS  Google Scholar 

  16. Riehle KJ, Dan YY, Campbell JS, Fausto N. New concepts in liver regeneration: new concepts in liver regeneration. J Gastroenterol Hepatol. 2011;26:203–12.

    Article  Google Scholar 

  17. Lehmann K, Tschuor C, Rickenbacher A, Jang J, Oberkofler CE, Tschopp O, et al. Liver failure after extended hepatectomy in mice is mediated by a p21-dependent barrier to liver regeneration. Gastroenterology. 2012;143:1609–19.

    Article  CAS  Google Scholar 

  18. Cataldegirmen G, Zeng S, Feirt N, Ippagunta N, Dun H, Qu W, et al. RAGE limits regeneration after massive liver injury by coordinated suppression of TNF-α and NF-κB. J Exp Med. 2005;201:473–84.

    Article  CAS  Google Scholar 

  19. Michalopoulos GK. Liver regeneration. J Cell Physiol. 2007;213:286–300.

    Article  CAS  Google Scholar 

  20. Kito Y, Nagino M, Nimura Y. Doppler sonography of hepatic arterial blood flow velocity after percutaneous transhepatic portal vein embolization. Am J Roentgenol. 2001;176:909–12.

    Article  CAS  Google Scholar 

  21. Eipel C. Regulation of hepatic blood flow: the hepatic arterial buffer response revisited. World J Gastroenterol. 2010;16:6046.

    Article  Google Scholar 

  22. Yokoyama Y, Nagino M, Nimura Y. Mechanisms of hepatic regeneration following portal vein embolization and partial hepatectomy: a review. World J Surg. 2007;31:367–74.

    Article  CAS  Google Scholar 

  23. Lautt WW. Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. Am J Phys. 1985;249:G549–56.

    CAS  Google Scholar 

  24. Charnsangavej C, Clary B, Fong Y, Grothey A, Pawlik TM, Choti MA. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol. 2006;13:1261–8.

    Article  Google Scholar 

  25. Schadde E, Malagó M, Hernandez-Alejandro R, Li J, Abdalla E, Ardiles V, et al. Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy. Surgery. 2015;157:676–89.

    Article  Google Scholar 

  26. Heymsfield SB, Fulenwider T, Nordlinger B, Barlow R, Sones P, Kutner M. Accurate measurement of liver, kidney, and spleen volume and mass by computerized axial tomography. Ann Intern Med. 1979;90:185–7.

    Article  CAS  Google Scholar 

  27. Lodewick TM, Arnoldussen CWKP, Lahaye MJ, van Mierlo KMC, Neumann UP, Beets-Tan RG, et al. Fast and accurate liver volumetry prior to hepatectomy. HPB (Oxford). 2016;18:764–72.

    Article  Google Scholar 

  28. Hermoye L, Laamari-Azjal I, Cao Z, Annet L, Lerut J, Dawant BM, et al. Liver segmentation in living liver transplant donors: comparison of semiautomatic and manual methods. Radiology. 2005;234:171–8.

    Article  Google Scholar 

  29. Pomposelli JJ, Tongyoo A, Wald C, Pomfret EA. Variability of standard liver volume estimation versus software-assisted total liver volume measurement. Liver Transpl. 2012;18:1083–92.

    Article  Google Scholar 

  30. Vauthey J-N, Abdalla EK, Doherty DA, Gertsch P, Fenstermacher MJ, Loyer EM, et al. Body surface area and body weight predict total liver volume in Western adults. Liver Transpl. 2002;8:233–40.

    Article  Google Scholar 

  31. Johnson TN, Tucker GT, Tanner MS, Rostami-Hodjegan A. Changes in liver volume from birth to adulthood: a meta-analysis. Liver Transpl. 2005;11:1481–93.

    Article  Google Scholar 

  32. Lafaro K, Buettner S, Maqsood H, Wagner D, Bagante F, Spolverato G, et al. Defining post hepatectomy liver insufficiency: where do we stand? J Gastrointest Surg. 2015;19:2079–92.

    Article  Google Scholar 

  33. Hyder O, Pulitano C, Firoozmand A, Dodson R, Wolfgang CL, Choti MA, et al. A risk model to predict 90-day mortality among patients undergoing hepatic resection. J Am Coll Surg. 2013;216:1049–56.

    Article  Google Scholar 

  34. Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, et al. The “50-50 Criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242:824–9.

    Article  Google Scholar 

  35. Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149:713–24.

    Article  Google Scholar 

  36. Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S, et al. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg. 2007;204:854–62.

    Article  Google Scholar 

  37. Schadde E, Raptis DA, Schnitzbauer AA, Ardiles V, Tschuor C, Lesurtel M, et al. Prediction of mortality after ALPPS stage-1: an analysis of 320 patients from the International ALPPS Registry. Ann Surg. 2015;262:780–6.

    Article  Google Scholar 

  38. Lam CM, Fan ST, Lo CM, Wong J. Major hepatectomy for hepatocellular carcinoma in patients with an unsatisfactory indocyanine green clearance test. Br J Surg. 1999;86:1012–7.

    Article  CAS  Google Scholar 

  39. Cieslak KP, Bennink RJ, de Graaf W, van Lienden KP, Besselink MG, Busch ORC, et al. Measurement of liver function using hepatobiliary scintigraphy improves risk assessment in patients undergoing major liver resection. HPB (Oxford). 2016;18:773–80.

    Article  Google Scholar 

  40. Chapelle T, Op De Beeck B, Huyghe I, Francque S, Driessen A, Roeyen G, et al. Future remnant liver function estimated by combining liver volumetry on magnetic resonance imaging with total liver function on 99mTc-mebrofenin hepatobiliary scintigraphy: can this tool predict post-hepatectomy liver failure? HPB (Oxford). 2016;18:494–503.

    Article  Google Scholar 

  41. de Graaf W, van Lienden KP, Dinant S, Roelofs JJTH, Busch ORC, Gouma DJ, et al. Assessment of future remnant liver function using hepatobiliary scintigraphy in patients undergoing major liver resection. J Gastrointest Surg. 2010;14:369–78.

    Article  Google Scholar 

  42. Muratore A, Zimmitti G, Ribero D, Mellano A, Viganò L, Capussotti L. Chemotherapy between the first and second stages of a two-stage hepatectomy for colorectal liver metastases: should we routinely recommend it? Ann Surg Oncol. 2012;19:1310–5.

    Article  Google Scholar 

  43. Wicherts DA, Miller R, de Haas RJ, Bitsakou G, Vibert E, Veilhan L-A, et al. Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg. 2008;248:994–1005.

    Article  Google Scholar 

  44. Narita M, Oussoultzoglou E, Bachellier P, Rosso E, Pessaux P, Jaeck D. Two-stage hepatectomy procedure to treat initially unresectable multiple bilobar colorectal liver metastases: technical aspects. Dig Surg. 2011;28:121–6.

    Article  CAS  Google Scholar 

  45. Robles R, Marín C, Lopez-Conesa A, Capel A, Perez-Flores D, Parrilla P. Comparative study of right portal vein ligation versus embolisation for induction of hypertrophy in two-stage hepatectomy for multiple bilateral colorectal liver metastases. Eur J Surg Oncol. 2012;38:586–93.

    Article  CAS  Google Scholar 

  46. Homayounfar K, Liersch T, Schuetze G, Niessner M, Goralczyk A, Meller J, et al. Two-stage hepatectomy (R0) with portal vein ligation—towards curing patients with extended bilobular colorectal liver metastases. Int J Color Dis. 2009;24:409–18.

    Article  CAS  Google Scholar 

  47. Pandanaboyana S, Bell R, Hidalgo E, Toogood G, Prasad KR, Bartlett A, et al. A systematic review and meta-analysis of portal vein ligation versus portal vein embolization for elective liver resection. Surgery. 2015;157:690–8.

    Article  Google Scholar 

  48. Vyas S, Markar S, Partelli S, Fotheringham T, Low D, Imber C, et al. Portal vein embolization and ligation for extended hepatectomy. Indian J Surg Oncol. 2014;5:30–42.

    Article  Google Scholar 

  49. Mise Y, Aloia TA, Conrad C, Huang SY, Wallace MJ, Vauthey J-N. Volume regeneration of segments 2 and 3 after right portal vein embolization in patients undergoing two-stage hepatectomy. J Gastrointest Surg. 2015;19:133–41.

    Article  Google Scholar 

  50. Loffroy R, Favelier S, Chevallier O, Estivalet L, Genson P-Y, Pottecher P, et al. Preoperative portal vein embolization in liver cancer: indications, techniques and outcomes. Quant Imaging Med Surg. 2015;5:730–9.

    PubMed  PubMed Central  Google Scholar 

  51. Avritscher R, de Baere T, Murthy R, Deschamps F, Madoff DC. Percutaneous transhepatic portal vein embolization: rationale, technique, and outcomes. Semin Intervent Radiol. 2008;25:132–45.

    Article  Google Scholar 

  52. de Baere T, Denys A, Paradis V. Comparison of four embolic materials for portal vein embolization: experimental study in pigs. Eur Radiol. 2009;19:1435–42.

    Article  Google Scholar 

  53. de Baere T, Teriitehau C, Deschamps F, Catherine L, Rao P, Hakime A, et al. Predictive factors for hypertrophy of the future remnant liver after selective portal vein embolization. Ann Surg Oncol. 2010;17:2081–9.

    Article  Google Scholar 

  54. Fischman AM, Ward TJ, Horn JC, Kim E, Patel RS, Nowakowski FS, et al. Portal vein embolization before right hepatectomy or extended right hepatectomy using sodium tetradecyl sulfate foam: technique and initial results. J Vasc Interv Radiol. 2014;25:1045–53.

    Article  Google Scholar 

  55. Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243:364–72.

    Article  Google Scholar 

  56. Madoff DC, Abdalla EK, Gupta S, Wu T-T, Morris JS, Denys A, et al. Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol. 2005;16:215–25.

    Article  Google Scholar 

  57. Lam VWT, Laurence JM, Johnston E, Hollands MJ, Pleass HCC, Richardson AJ. A systematic review of two-stage hepatectomy in patients with initially unresectable colorectal liver metastases. HPB (Oxford). 2013;15:483–91.

    Article  Google Scholar 

  58. Koopman M, Antonini NF, Douma J, Wals J, Honkoop AH, Erdkamp FL, et al. Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (CAIRO): a phase III randomised controlled trial. Lancet. 2007;370:135–42.

    Article  CAS  Google Scholar 

  59. Chua TC, Liauw W, Chu F, Morris DL. Summary outcomes of two-stage resection for advanced colorectal liver metastases: two-stage resection of CLM. J Surg Oncol. 2013;107:211–6.

    Article  Google Scholar 

  60. Baumgart J, Lang S, Lang H. A new method for induction of liver hypertrophy prior to right trisectionectomy: a report of three cases. HPB (Oxford). 2011;13(suppl 2):1–145.

    Google Scholar 

  61. de SE, Alvarez FA, Ardiles V. How to avoid postoperative liver failure: a novel method. World J Surg. 2011;36:125–8.

    Google Scholar 

  62. de Santibañes E, Clavien P-A. Playing Play-Doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg. 2012;255:415–7.

    Article  Google Scholar 

  63. Schnitzbauer AA, Lang SA, Goessmann H, Nadalin S, Baumgart J, Farkas SA, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012;255:405–14.

    Article  Google Scholar 

  64. Edmondson MJ, Sodergren MH, Pucher PH, Darzi A, Li J, Petrowsky H, et al. Variations and adaptations of associated liver partition and portal vein ligation for staged hepatectomy (ALPPS): many routes to the summit. Surgery. 2016;159:1058–72.

    Article  Google Scholar 

  65. Li J, Kantas A, Ittrich H, Koops A, Achilles EG, Fischer L, et al. Avoid “All-Touch” by Hybrid ALPPS to achieve oncological efficacy. Ann Surg. 2016;263:e6–7.

    Article  Google Scholar 

  66. Linecker M, Kambakamba P, Reiner CS, Linh Nguyen-Kim TD, Stavrou GA, Jenner RM, et al. How much liver needs to be transected in ALPPS? A translational study investigating the concept of less invasiveness. Surgery. 2017;161:453–64.

    Article  Google Scholar 

  67. Robles R, Parrilla P, López-Conesa A, Brusadin R, de la Peña J, Fuster M, et al. Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure. Br J Surg. 2014;101:1129–34.

    Article  CAS  Google Scholar 

  68. Pineda-Solís K, Paskar D, Tun-Abraham M, Hernandez-Alejandro R. Expanding the limits of resectability: associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) using monosegment 6, facilitated by an inferior right hepatic vein. J Surg Oncol. 2017;115(8):959–62.

    Article  Google Scholar 

  69. Machado MAC, Makdissi FF, Surjan RC, Basseres T, Schadde E. Transition from open to laparoscopic ALPPS for patients with very small FLR: the initial experience. HPB (Oxford). 2017;19:59–66.

    Article  Google Scholar 

  70. Wanis KN, Buac S, Linecker M, Ardiles V, Tun-Abraham ME, Robles-Campos R, et al. Patient survival after simultaneous ALPPS and colorectal resection. World J Surg. 2017;41:1119–25.

    Article  Google Scholar 

  71. Croome KP, Hernandez-Alejandro R, Parker M, Heimbach J, Rosen C, Nagorney DM. Is the liver kinetic growth rate in ALPPS unprecedented when compared with PVE and living donor liver transplant? A multicentre analysis. HPB (Oxford). 2015;17:477–84.

    Article  Google Scholar 

  72. Schlegel A, Lesurtel M, Melloul E, Limani P, Tschuor C, Graf R, et al. ALPPS: from human to mice highlighting accelerated and novel mechanisms of liver regeneration. Ann Surg. 2014;260:839–47.

    Article  Google Scholar 

  73. Truant S, Scatton O, Dokmak S, Regimbeau J-M, Lucidi V, Laurent A, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): impact of the inter-stages course on morbi-mortality and implications for management. Eur J Surg Oncol. 2015;41:674–82.

    Article  CAS  Google Scholar 

  74. Nagino M, Kanai M, Morioka A, Yamamoto H, Kawabata Y, Hayakawa N, et al. Portal and arterial embolization before extensive liver resection in patients with markedly poor functional reserve. J Vasc Interv Radiol. 2000;11(8):1063.

    Article  CAS  Google Scholar 

  75. Hwang S, Lee S-G, Ko G-Y, Kim B-S, Sung K-B, Kim M-H, et al. Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Ann Surg. 2009;249:608–16.

    Article  Google Scholar 

  76. Tschuor C, Croome KP, Sergeant G, Cano V, Schadde E, Ardiles V, et al. Salvage parenchymal liver transection for patients with insufficient volume increase after portal vein occlusion – an extension of the ALPPS approach. Eur J Surg Oncol. 2013;39:1230–5.

    Article  Google Scholar 

  77. Enne M, Shadde E, Björnsson B, Hernandez Alejandro R, Gayet B, Steinbruck K, et al. The ALPPS as salvage procedure after unsuccessful portal vein occlusion. “Give then another chance….”. HPB (Oxford). 2016;e6:18.

    Google Scholar 

  78. Torres OJM, Fernandes E de SM, Oliveira CVC, Lima CX, Waechter FL, Moraes-Junior JMA, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): the Brazilian experience. Arq Bras Cir Dig. 2013;26:40–3.

    Article  Google Scholar 

  79. Li J, Girotti P, Königsrainer I, Ladurner R, Königsrainer A, Nadalin S. ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure? J Gastrointest Surg. 2013;17:956–61.

    Article  Google Scholar 

  80. Knoefel WT, Gabor I, Rehders A, Alexander A, Krausch M, Schulte am Esch J, et al. In situ liver transection with portal vein ligation for rapid growth of the future liver remnant in two-stage liver resection. Br J Surg. 2013;100:388–94.

    Article  CAS  Google Scholar 

  81. Ratti F, Cipriani F, Gagliano A, Catena M, Paganelli M, Aldrighetti L. Defining indications to ALPPS procedure: technical aspects and open issues. Updat Surg. 2013;66:41–9.

    Article  Google Scholar 

  82. Schadde E, Ardiles V, Slankamenac K, Tschuor C, Sergeant G, Amacker N, et al. ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis. World J Surg. 2014;38:1510–9.

    Article  Google Scholar 

  83. Schadde E, Ardiles V, Robles-Campos R, Malago M, Machado M, Hernandez-Alejandro R, et al. Early survival and safety of ALPPS: first report of the International ALPPS Registry. Ann Surg. 2014;260:829–38.

    Article  Google Scholar 

  84. Hernandez-Alejandro R, Bertens KA, Pineda-Solis K, Croome KP. Can we improve the morbidity and mortality associated with the associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) procedure in the management of colorectal liver metastases? Surgery. 2015;157:194–201.

    Article  Google Scholar 

  85. Alvarez FA, Ardiles V, de Santibañes M, Pekolj J, de Santibañes E. Associating liver partition and portal vein ligation for staged hepatectomy offers high oncological feasibility with adequate patient safety: a prospective study at a single center. Ann Surg. 2015;261:723–32.

    Article  Google Scholar 

  86. Eshmuminov D, Raptis DA, Linecker M, Wirsching A, Lesurtel M, Clavien P-A. Meta-analysis of associating liver partition with portal vein ligation and portal vein occlusion for two-stage hepatectomy. Br J Surg. 2016;103:1768–82.

    Article  CAS  Google Scholar 

  87. Björnsson B, Sparrelid E, Røsok B, Pomianowska E, Hasselgren K, Gasslander T, et al. Associating liver partition and portal vein ligation for staged hepatectomy in patients with colorectal liver metastases – intermediate oncological results. Eur J Surg Oncol. 2016;42:531–7.

    Article  Google Scholar 

  88. Røsok BI, Björnsson B, Sparrelid E, Hasselgren K, Pomianowska E, Gasslander T, et al. Scandinavian multicenter study on the safety and feasibility of the associating liver partition and portal vein ligation for staged hepatectomy procedure. Surgery. 2016;159:1279–86.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, London Health Sciences Centre, Western University, London, ON, Canada

    Kerollos Nashat Wanis

  2. Division of Transplantation, HPB Surgery, Department of Surgery, University of Rochester, Rochester, NY, USA

    Roberto Hernandez-Alejandro

Authors
  1. Kerollos Nashat Wanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberto Hernandez-Alejandro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Hernandez-Alejandro .

Editor information

Editors and Affiliations

  1. Division of Surgical Oncology, Winship Cancer Institute, Emory University Hospital Midtown, Atlanta, GA, USA

    Kenneth Cardona

  2. Division of Surgical Oncology, Winship Cancer Institute, Emory University Hospital, Atlanta, GA, USA

    Shishir K. Maithel

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wanis, K.N., Hernandez-Alejandro, R. (2018). Two-Stage Approach to Liver Resection. In: Cardona, K., Maithel, S. (eds) Primary and Metastatic Liver Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-91977-5_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-91977-5_28

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91976-8

  • Online ISBN: 978-3-319-91977-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation