Associating liver partition and portal vein ligation for staged hepatectomy in the treatment of colorectal cancer liver metastases

Abstract

Colorectal cancer (CRC) is a common malignancy of the digestive system. Colorectal liver cancer metastasis (CRLM) occurs in approximately 50% of the patients and is the main cause of CRC mortality. Surgical resection is currently the most effective treatment for CRLM. However, given that the remnant liver volume after resection should be adequate, only a few patients are suitable for radical resection. Since Dr. Hans Schlitt first performed the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for CRLM in 2012, ALPPS has received considerable attention and has continually evolved in recent years. This review explains the technical origin of the ALPPS procedure for CRLM and evaluates its efficacy, pointing to its favorable postoperative outcomes. We also discuss the patient screening strategies and optimization of ALPPS to ensure long-term survival of patients with CRLM in whom surgery cannot be performed. Finally, further directions in both basic and clinical research regarding ALPPS have been proposed. Although ALPPS surgery is a difficult and high-risk technique, it is still worth exploration by experienced surgeons.

Keywords: Associating liver partition and portal vein ligation for staged hepatectomy; Colorectal liver cancer metastases; Portal embolization; Portal ligation; Two-stage hepatectomy.

Figure 1

First long-term oncologic results of the associating liver partition and portal vein ligation for staged hepatectomy procedure in a large cohort of patients with colorectal liver metastases[25]. Kaplan–Meier plots for cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). The median CSS, OS, and RFS were 42, 37, and 11 mo, respectively. The 3- and 5-year CSS, OS, and RFS were 59%, 52%, and 19%, and 33%, 27%, and 12%, respectively. Citation: Petrowsky H, Linecker M, Raptis DA, Kuemmerli C, Fritsch R, Kirimker OE, Balci D, Ratti F, Aldrighetti L, Voskanyan S, Tomassini F, Troisi RI, Bednarsch J, Lurje G, Fard-Aghaie MH, Reese T, Oldhafer KJ, Ghamarnejad O, Mehrabi A, Abraham MET, Truant S, Pruvot FR, Hoti E, Kambakamba P, Capobianco I, Nadalin S, Fernandes ESM, Kron P, Lodge P, Olthof PB, van Gulik T, Castro-Benitez C, Adam R, Machado MA, Teutsch M, Li J, Scherer MN, Schlitt HJ, Ardiles V, de Santibañes E, Brusadin R, Lopez-Lopez V, Robles-Campos R, Malagó M, Hernandez-Alejandro R, Clavien PA. First long-term oncologic results of the ALPPS procedure in a large cohort of patients with colorectal liver metastases. Annals of surgery 2020; 272: 793-800. Copyright^© 2020 Wolters Kluwer Health, Inc.