ALPPS with one liver remnant segment: A case report

Abstract

Introduction: Since 2011 associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) allows to resect patients with colorectal liver metastases (mets) initially unresectable. Method: Male 53 y.o bearing stage IV colorectal cancer, with unresectable multiple bilateral mets. Neoadjuvant (FOLFOX + Avastin) treatment was performed and then colonic primary tumor was operated on. Adjuvant therapy (FOLFIRI + bevacizumab) was indicated. Evaluated by HPB surgery unit (CT-scan – Magnetic Resonance – Pet-CT-scan) a surgical approach was considered (ALPPS). -First time: Radiofrequency ablation of single lesion in segment IV. Metastasectomy in segment I. Left lateral seccionectomy. Right portal vein ligation. Liver partition respecting right hepatic artery and bile duct. -Volumetry of the future remnant liver on the sixth day (546 cc). -Second time: Right hepatectomy: liver partition is complete. Liver remnant: Segment IV. It did not require transfusions, ICU stay 48 hours. Result: Mild jaundice and postoperative ascites, which were self limited. Discharge on the seventh day. On first month control: tomographic, clinical and laboratory markers were normal, good hepatic function and absence of liver nodules. Capecitabine adjuvant therapy is currently on course. The quality of life of the patients is good. Conclusion: In selected cases ALPPS is valid approch to achieve resectability of patients initially unresectable. In a short period time (7/10 days) this technique enables to accomplish R0 resection. Well then adyuvant therapy can be started.