When very large hepatocellular carcinomas (HCCs) and intrahepatic cholangiocarcinoma (IHCCs) with insufficient future liver remnants are treated using associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), the outcome is often poor. We therefore tested the efficacy of a modified version of that technique, tourniquet-ALPPS. A review of the literature examining outcomes of HCC and IHCC patients treated with ALPPS revealed the incidences of morbidity ≥ III and postoperative mortality to be respectively 20.7% and 16.1% among HCC patients and 50% and 45.4% among IHCC patients. In the present case series, in which HCC and IHCC patients were treated with tourniquet-ALPPS, median tumor size was 100 mm (range: 70–200 mm). After surgical stage I, there was no morbidity, no mortality and the median future liver remnant had increased at day 7 by 76%. In surgical stage II, 100% of tumors were resectable (8 right trisectionectomies, 5 with inferior vena cava resection). Two patients experienced serious morbidity ≥ IIIB and 1 patient died (11%). One- and 3-year overall survival was 75% and 60%, respectively. Thus tourniquet-ALPPS appears to be an effective alternative to classical ALPPS for the treatment of patients with HCC or IHCC.

chemotherapy with capecitabine as postoperative adjuvant chemotherapy. Eight months after the operation, the contrast enhanced computed tomography revealed two low density lesions in the liver. The hepatobiliary phase of the EOB-MRI demonstrated three lesions in the liver as hypointense tumors relative to the surrounding hepatic parenchyma. These findings of the preoperative images were compatible to metastatic liver tumors from the rectal cancer, and we performed limited resection of the liver. Histopathological findings of three lesions which were recognized preoperatively revealed that sinusoid within lobules dilated and space of Disse bled. It indicated sinusoidal obstruction injury. There was no malignant lesion. The patient recovered completely and discharged from our hospital on 7th postoperative day. Conclusions: Focal HSOS mimicking metastatic liver tumors is very rare, and it is difficult to discriminate between focal HSOS and liver metastases in the patients who undergo oxaliplatin-based chemotherapy.