Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for colorectal liver metastasis (CRLM): a single-center experience and review of the literature

Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) is increasingly used for the treatment of primarily unresectable colorectal liver metastases (CRLM) because of the insufficient future liver remnant (FLR). The aim of this study was to share our experience with ALPPS for advanced CRLM and review the role of ALPPS in the management of patients with CRLM. Consecutive patients (n = 10) with CRLM who underwent ALPPS at our center between December 2014 and October 2021 were retrospectively studied. The median age of patients was 58 years (range 49–70 years). Five patients had metachronous CRLM and the other 5 patients had synchronous CRLM. Five patients had unilateral CRLM and the other 5 patients had bilateral CRLM. All patients previously underwent neoadjuvant chemotherapy. The FLR volume increased by 45.3% (35.8%–61.6%) over 14 days (range 7–21 days). The absolute and relative kinetic growth rates were 17.9 mL/day (range 7.5–32.1 mL/day) and 4.6%/day (range 2.3%–8.8%/day), respectively. Overall morbidity rates were 20% (2/10) and 40% (4/10) after ALPPS stage 1 and stage 2, respectively. The 30-day and 90-day mortality rates were 0% and 10%, respectively. R0 resection was achieved for all patients, and the median disease-free survival was 18.7 months. ALPPS is an effective treatment option for advanced CRLM. It enables rapid hypertrophy of the FLR and achieves a high R0 resection rate with an acceptable oncological outcome. However, ALPPS should be reserved for selected patients because of its relatively high morbidity and mortality.