Associating Liver Partition With Portal Vein Ligation For Staged Hepatectomy (ALPPS) or Portal Vein Occlusion in Treating Patients With Liver Cancer

Inclusion Criteria:

* Patient may have primary or secondary hepatic malignancies with a FLR/TLV \< 30% or a FLR/BW ratio of \< 0.5 for patients with normal liver function (defined as normal transaminases, normal bilirubin, normal factor V, and normal PT/INR). In case of injury due to chemotherapy, known high grade steatosis, or cholestasis \> 50 mmol/L, patient may be enrolled into the trial if FLR/TLV is \< 40% or FLR/BW ratio \< 0.8.
* Patient must have extensive liver tumors that would require portal vein embolization or a two-stage hepatectomy and portal vein embolization or ligation by the judgment of surgeons in the tumor board.
* Patient may have extrahepatic disease as long as it may be addressed after liver surgery and there is a tumor board decision to proceed with liver resection (mostly applicable to CRC metastases).
* Patient may have received previous chemotherapy.
* In cases of cholestasis, preoperative drainage procedures (PTC or ERCP) are left up to judgement of physicians.
* Patient must be ≥ 18 years of age. The patient population over 65 years old needs to be carefully included based on comorbidities.
* Patient may have undergone previous liver resection.
* Patient's location must be such that proper staging and follow-up may be performed.
* Patient's case must be presented at the Multidisciplinary Meeting attended by hepatobiliary surgeons, oncologists, hepatologists, and radiologists, or must be approved directly by Dr. Strasberg or Dr. Chapman.
* Patient must be able to understand and willing to sign a written informed consent document.

Exclusion Criteria:

* Patient must not have any significant concomitant diseases rendering him/her unsuitable for major liver surgery by the judgment of the physicians involved, especially if the patient is \> 65 years old.
* Patient must not have enrolled into a clinical trial within 4 weeks of study entry.
* Patient must not have peritoneal carcinomatosis or other extensive extrahepatic disease.
* Patient must not have advanced stages of carcinoma of the gallbladder (T3/T4)
* Patient must not have issues such as drug and/or alcohol abuse.
* Patient must not need major extrahepatic surgery (e.g. pancreas resection, gastric resection, rectal surgery) within 3 months of study entry.
* Patient must not be a candidate for liver transplantation in case of HCC.
* Patient must not be pregnant or breastfeeding. If a female of childbearing potential, patient must have a negative pregnancy test within 14 days of enrollment.

Inclusion of Women and Minorities

-Both men and women and members of all races and ethnic groups are eligible for this trial.