Patient Survival After Simultaneous ALPPS and Colorectal Resection

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Synchronous colorectal cancer and liver metastases (CRLM) often require liver resection combined with colorectal surgery (CRS) for curative intent.
• Simultaneous resection is beneficial for low hepatic tumor burden.
• The safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with CRS for extensive CRLM and small future liver remnant (FLR) remain controversial due to limited outcome data.

Purpose of the Study:

• To evaluate the outcomes of simultaneous ALPPS and CRS in patients with extensive CRLM.
• To identify factors associated with 90-day mortality after stage-2 ALPPS in this cohort.

Main Methods:

• A prospective analysis of 31 cases from the International ALPPS Registry undergoing simultaneous ALPPS and CRS.
• Univariate analysis was employed to determine predictors of 90-day mortality post-stage-2.

Main Results:

• Thirty patients completed both stages, with CRS performed during stage-1 in 73%.
• A 15% 90-day mortality rate was observed, with 23% experiencing severe complications (Clavien-Dindo ≥ IIIb) after stage-2.
• Severe complications post-stage-1 and a MELD score > 10 on postoperative day-5 after stage-1 were significantly associated with 90-day mortality.

Conclusions:

• The high mortality and poor survival reported suggest that simultaneous ALPPS and CRS should not be widely adopted for extensive CRLM without further investigation.
• Patients with severe complications or elevated MELD scores after the first stage face increased mortality risk in the second stage.