ALPPS in patients with colorectal liver metastases

Abstract

Background: The Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) approach allows achieving resectability of liver malignancies by a rapid and large future liver remnant (FLR) hypertrophy. However, the long-term oncological outcomes of this approach in patients with colorectal liver metastases (CLM) remain unclear. Methods: A single-prospective-cohort study between June 2011 and august 2015 including patients with CLM who underwent ALPPS. Results: Twenty-four patients were treated. Mean age was 55.8 y (range = 35-81) and 17 were males (71%). Twenty-two patients received a mean of 7.5 cycles of preoperative chemotherapy, all of them having either a good morphological response (n = 18) or stable disease (n = 4) before surgery. In a median of 6 days (range = 4-67) the median FLR hypertrophy was 106% (range = 286–21.5). All patients completed the second stage (100% feasibility). Seven patients underwent a simultaneous resection of the primary tumor. Morbidity according to the Dindo-Clavien classification was 58.3% and grade ≥IIIb 20.8%. The mortality was nil. Median hospital stay was 17.5 days (r = 9–49). Within a mean follow-up of 20.4 months, seventeen patients experienced recurrence. Mean time to progresion was 8.7 months. The overall and disease-free survival at one year was 77% and 44%, at two years was 60% and 20%, and at three years was 53% and 17% respectively. Conclusions: The present study shows that ALPPS has a high safety profile in patients with CLM. The oncological outcomes provided by ALPPS so far seem similar to that of other surgical strategies in patients with initially unresectable disease and dismal prognosis.