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Updated: Sep 12, 2025
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Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure
Published on: August 14, 2017
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Liver Transplantation Versus ALPPS for Colorectal Liver Metastases: An Entropy Balanced Retrospective Analysis
Matteo Serenari1,2, Jacopo Lanari3,4, Svein Dueland5
1Hepato-biliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Annals of Surgery
|August 8, 2025
Summary
Liver transplantation (LT) and Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) offer similar survival for colorectal liver metastases (CRLM). Success depends on completing ALPPS stage 2 and meeting transplant criteria.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is used for borderline colorectal liver metastases (CRLM).
- Published oncological outcomes for ALPPS appear inferior to liver transplantation (LT).
Purpose of the Study:
- To compare the efficacy of liver transplantation (LT) versus Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) in treating colorectal liver metastases (CRLM).
Main Methods:
- A comparative study of 46 patients undergoing ALPPS for CRLM (2012-2022) and 54 patients undergoing LT (2006-2019).
- Entropy balancing was used to control for confounding factors between the two groups.
- Subgroup analyses were performed for completed vs. failed ALPPS and SECA-II criteria.
Main Results:
- Overall survival (OS) was similar between ALPPS (76 months) and LT (72.7 months) groups. No significant difference in mortality risk was found between ALPPS and LT after reweighting.
- Patients with failed ALPPS had significantly lower median OS (31.1 months) compared to LT patients (P=0.043).
- For patients meeting SECA-II criteria, LT showed significantly higher median OS (not reached) compared to ALPPS (76 months, P=0.022).
Conclusions:
- Liver transplantation (LT) without stringent selection criteria did not demonstrate a significant survival advantage over ALPPS for CRLM.
- The choice between LT and ALPPS should consider the feasibility of completing ALPPS stage 2 and adherence to current transplant eligibility criteria.
