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Background: Due to the unfavorable reported outcome in ALPPS, a precise risk stratification is needed. Based on the International ALPPS Registry, we have recently proposed two easily applicable risk models (pre-stage1 and 2) for predicting 90-day mortality in ALPPS but a validation of both models has not yet been performed. Methods: One year after the development of the ALPPS risk model, the ALPPS registry was screened for subsequent cases not used for the development cohort (DC) of the risk model. Four centers outside the ALPPS registry were contacted to provide additional ALPPS cases. Pre-stage 1 and 2 futility risks were calculated for each patient according to the developed risk formula. ROC curve analysis was performed to assess the predictive ability of the ALPPS risk model in the validation cohort (VC). Results: The VC was composed of a total of 176 patients including 36 patients outside the ALPPS registry with 30 cases of early mortalities (17%). The DC and VC were comparable in terms of patient and surgery characteristics. The VC validated both models with an acceptable prediction for the pre-stage 1 (c-statistic 0.62, p=0.041 vs. 0.75, p<0.001) and an excellent prediction for the pre-stage 2 model (c-statistic 0.82, p<0.001 vs. 0.84, p<0.001) as compared to the DC. Conclusion: The ALPPS risk score is a validated tool to assess the individual risk of patients before stage-1 and stage-2 surgery. Risk adjustment in ALPPS using the risk score is an easy applicable strategy to make this procedure safer.

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We present a case of pancreatic resection for isolated MM metastasis along with a review of the English published literature. Patients with extra-pancreatic disease and patients who did not undergo surgery were excluded.We report a case of a 46-year-old woman, with a right arm MM excised nine years ago, who presented with an isolated tail of the pancreas mass on routine follow-up.Laparoscopic distal pancreatectomy and splenectomy was preformed and revealed a 28mm metastatic MM, with negative resection margins.The patient is asymptomatic with no recurrence 10 months after the resection. No adjuvant treatment was given.The literature review revealed 3 case series and 21 case reports with a total of 37 patients. The follow-up ranged from 1-264 months with a 5 year survival of 37,5% reported.It appears that in carefully selected patients surgery may offer an overall survival benefit.Resection of isolated pancreatic metastases should be considered as it may provide a significant survival benefit for a disease with high mortality and lack of effective systemic therapies. Multidisciplinary decision and treatment in high volume centres is mandatory.