• MachadoMarcel C CMCCDepartment of Surgery, University of São Paulo, Brazil., Emerson S Abe, Rodrigo Dumarco, Públio Viana, and MachadoMarcel Autran CMAC.
• Department of Surgery, University of São Paulo, Brazil.
• Medicine (Baltimore). 2018 Aug 1; 97 (31): e11656.

RationaleThe associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure is a recently introduced treatment strategy for patients with advanced primary or metastatic liver tumors and small future liver remnants. ALPPS procedure using ischemic bipartition of the liver is a modified technique that may reduce complications compared to classical ALPPS.Patient ConcernsTwo patients with multiple colorectal liver metastasis with extensive involvement of the liver were considered unresectable before treatment because of small future liver remnant (FLR).DiagnosesTwo patients were diagnosed by imaging examination with volumetry of the liver.InterventionsIn the first stage, ischemic bipartition of the liver is achieved using radiofrequency ablation. The Glissonian pedicles from Segment 4 are identified and ablated, the FLR is cleared, and the right portal vein is ligated. In the second stage, the typical procedure is performed, and an extended liver resection is performed.OutcomesThe procedure was feasible with acceptable hypertrophy of FLRs. Blood transfusions were unnecessary, and severe postoperative complications were avoided.LessonsThe ALPPS procedure with ischemic bipartition is safe and feasible and can produce results that are the same as those of the classical ALPPS procedure while reducing invasiveness during the first stage.

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