The ALPPS Approach for the Management of Colorectal Carcinoma Liver Metastases

Liver resection is the treatment of choice for patients with colorectal liver metastases (CRLM). The possibility of achieving curative resection is limited by the future liver remnant (FLR), with posthepatectomy liver failure (PHLF) the most severe possible complication after major liver resection. Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been introduced as a strategy for prevention of PHLF by inducing a rapid and large FLR hypertrophy not achieved by other methods. To date, most of the evidence regarding ALPPS is based on retrospective analysis of small series of patients or of case reports. The promising short-term results obtained are difficult to interpret oncologically, because of the heterogeneous groups of patients with different underlying pathology, variable chemotherapy use, and technical variations applied. Only increased experience and long-term outcomes will better define the utility of this novel method.