Monosegment ALPPS for bilateral colorectal liver metastasis - One is enough

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Extensive liver resections for extensive liver metastases require strategies to ensure adequate future liver remnant.
• Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an option for patients with insufficient liver remnant.
• Monosegment ALPPS, leaving only one liver segment as remnant, is a modification of the original ALPPS procedure.

Observation:

• A 63-year-old man with bilobar colorectal liver metastasis underwent segment 4-1 ALPPS.
• The procedure involved two stages with a 21-day interval.
• The future liver remnant volume increased from 250 cc (18% of standard liver volume) to 694 cc (48% of standard liver volume).

Findings:

• Segment 4-1 ALPPS was successfully performed in a patient with extensive bilobar colorectal liver metastasis.
• The patient tolerated the procedure well, with a significant increase in liver remnant volume.
• The patient was disease-free ten months after liver surgery and subsequently underwent colectomy.

Implications:

• Monosegment ALPPS is a challenging but feasible option for selected patients requiring extensive liver resection.
• Careful patient selection and experienced surgical teams are crucial for successful outcomes in monosegment ALPPS.
• This approach can enable curative treatment for patients with extensive liver metastases previously considered unresectable.