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iLIVER 2022, 1(1): 25-29 https://doi.org/10.1016/j.iliver.2022.02.002
Original Article | Open Access | Issue | Published: 09 March 2022

Associating liver partition and portal vein ligation for staged hepatectomy ​for colorectal liver metastasis: a single-center experience

Show Author's Information Yuanfei Penga,f,1,  Feiyu Chena,f,1,  Zheng Wanga,f,1,  Xiaoying Wanga,f,  Yinghong Shia,f,  Zhenbing Dinga,f,  Yongsheng Xiaoa,f,  Kang Songa,f,  Lei Yua,f,  Jie Hua,f,  Min Tangb,  Zhaoyou Tanga,f,  Jia Fana,c,d,e,f( ),  Jian Zhoua,c,d,e,f( )
Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
Institute of Biomedical Sciences, Fudan University, Shanghai, China
State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China
Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai, China

1 These authors equally contributed to this study.

Keywords:
ALPPS, Colorectal liver metastasis, Future liver remnant
Cite this article:
Peng Y, Chen F, Wang Z, et al. Associating liver partition and portal vein ligation for staged hepatectomy ​for colorectal liver metastasis: a single-center experience. iLIVER, 2022, 1(1): 25-29. https://doi.org/10.1016/j.iliver.2022.02.002
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Abstract Full text About this article
Background

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.

Methods

Consecutive patients (n = 10) with CRLM who underwent ALPPS at our center between December 2014 and October 2021 were retrospectively studied.

Results

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.

Conclusions

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.


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Abstract
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About this article

Associating liver partition and portal vein ligation for staged hepatectomy ​for colorectal liver metastasis: a single-center experience

Show Author's information Yuanfei Penga,f,1, Feiyu Chena,f,1, Zheng Wanga,f,1, Xiaoying Wanga,f, Yinghong Shia,f, Zhenbing Dinga,f, Yongsheng Xiaoa,f, Kang Songa,f, Lei Yua,f, Jie Hua,f, Min Tangb, Zhaoyou Tanga,f, Jia Fana,c,d,e,f( ), Jian Zhoua,c,d,e,f( )
Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
Institute of Biomedical Sciences, Fudan University, Shanghai, China
State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China
Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai, China

1 These authors equally contributed to this study.

Abstract

Background

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.

Methods

Consecutive patients (n = 10) with CRLM who underwent ALPPS at our center between December 2014 and October 2021 were retrospectively studied.

Results

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.

Conclusions

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.

Keywords: ALPPS, Colorectal liver metastasis, Future liver remnant

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Publication history
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Publication history

Received: 05 December 2021
Revised: 06 February 2022
Accepted: 09 February 2022
Published: 09 March 2022
Issue date: March 2022

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© 2022 Published by Elsevier Ltd on behalf of Tsinghua University Press.

Acknowledgements

Acknowledgements

This work was supported by the grants from the National Natural Science Foundation of China (No. 82150004).

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This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

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