Outcomes of ALPPS for bilateral colorectal liver metastases compared to those of one-stage parenchymal sparing hepatectomy: a multicenter case-match analysis

Abstract

Introduction: About 30% of patients with colorectal liver metastases (CRLM) are not initially resectable due to the extent of hepatic disease. When the future liver remnant (FLR) is regarded to be not sufficient, classic two stage hepatectomy or associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can be performed to get increase of the FLR. One-stage ultrasound-guided parenchymal-sparing hepatectomy (OSH) may represent an alternative strategy for these patients. Method: A retrospective analysis of patients enrolled within the ALPPS Italian Registry between 2005 and 2017 was performed. Patients undergoing ALPPS for ≥3 bilateral CRLM were matched 1:2 with patients receiving a OSH at Humanitas Research Hospital. Patients were matched according to the Fong Score (1-2/3/4-5); the contact of CRLM with major intrahepatic vessels; the number of CRLM (3-7/≥8); the number of CRLM in the left liver (< /≥3); and the response to preoperative chemotherapy. The main end points of the study were perioperative outcomes, overall (OS) and disease-free survival (DFS). Results: Eighty-one patients were selected (27 ALPPS and 54 OSH) based on matching process. Demographic and tumor characteristics were similar between the two groups. The two treatments differed significantly in major morbidity (29.6% ALPPS vs 7.4% OSH, p=0.017) but with similar mortality rate (7.4% vs 1.8%, p=0.256). Median OS (31.7 vs 31.4 months) and DFS (7.2 vs 7.3 months) were comparable between the two groups. Conclusions: This case-match study demonstrates that ALPPS and OSH for bilateral CRLM achieve comparable OS and DFS, despite higher morbidity rates reported after ALPPS.