Liver partition and portal vein ligation improves long-term outcomes of patients with colorectal cancer and liver metastases

This study investigated the long-term outcomes of patients with colorectal cancer (CRC) and liver metastases (LM; cancer spread to the liver) undergoing the ALPPS (associating liver partition and portal vein ligation) procedure. Researchers suggested that patients with LM that were unfit for surgical removal achieved positive long-term outcomes and reduced mortality with this procedure.

CRC is the third most common cancer worldwide. Around 40% of patients present with metastatic disease at diagnosis. The liver is one of the most common sites for metastasis. Advanced liver disease means the involvement of both sides of the liver. These patients are usually not eligible for LM removal surgery.

The ALPPS procedure is a 2-stage surgery used to remove large parts of the liver in 7 to 14 days. This procedure separates the liver and ligates (ties up) the portal vein (a large blood vessel that drains blood from the digestive tract to the liver) to the diseased liver. The portal vein feeds the liver which increases the growth of remnant liver cells. Prior studies suggested that ALPPS is associated with improved mortality, despite the initial safety concerns. However, the long-term outcomes of treatment with ALPPS in patients with CRC and LM who are not considered fit for regular liver surgery are still not known.

This study included information about 510 patients with advanced CRC and LM. All participants were treated with ALPPS. 92% of all patients underwent chemotherapy before the procedure to shrink tumors. The average follow-up time was 38 months.

The average overall survival was 39 months and the average time without cancer recurrence was 15 months. The average cancer-specific survival (CSS; the length of time from treatment until death from cancer) was 42 months. The mortality rate after 90 days from surgery was 4.9%.

This study concluded that the ALPPS procedure is associated with improved long-term outcomes in patients with CRC and LM.

This study was based on information from medical records. Data may have been missing. Further studies are needed.