An initial experience with Partial ALPPS vs palliative chemotherapy in advanced colorectal liver metastases

Abstract

Background: Associating liver partition and portal vein ligation (ALPPS) is a novel 2-stage accelerated procedure to treat bilobar colorectal liver metastases with a curative intent. Partial ALPPS (p-ALPPS) is a modified technique whereby 50-80% liver is transected during stage 1. Data comparing survival outcome of p-ALPPS with palliative treatment is still limited. We aim to compare long-term survival of patients who underwent p-ALPPS with patients who received either palliative chemotherapy or best supportive care (BSC). Methods: We retrospectively reviewed 409 patients in our institution with colorectal liver metastases from January 2014 to December 2016. Patients with advanced colorectal liver metastases as defined by >6 metastases and/or > 6 involved segments were identified. These were grouped into 3 main categories: p-ALPPS, palliative chemotherapy and BSC. The median survival in each arm is calculated and compared. Results: 48 patients had advanced bilobar disease. 4 underwent p-ALPPs, 28 received palliative chemotherapy and 16 had BSC. In the p-ALPPS group, 3 have survived more than 365 days (range 366-457) and are still alive. However, 1 demised at 85 days due to chemotherapy related sepsis. Median survival for palliative chemotherapy and BSC are 315 and 97 days respectively. Conclusion: Early data suggests there is a role for p-ALPPS and palliative systemic chemotherapy compared to BSC alone. A more robust study of p-ALPPS outcomes is needed to draw meaningful comparison with palliative chemotherapy.