ALPPS for Colorectal Liver Metastases

Excerpt

For colorectal liver metastases, hepatic resection is currently the only treatment with a curative intent offering the chance of long-term survival. At the time of diagnosis, only a minor proportion of about 15–25 % of CRLM qualify for primary liver resection. Most often multifocal intrahepatic tumor spread or extensive tumor burden result either in technical or functional irresectability or make a possible resection questionable from the oncologic point of view. In cases of functional irresectability due to a small future liver remnant (FLR), portal vein embolization (PVE), and ligation (PVL) or two-stage hepatectomy, often in combination with PVE or PVL, have been shown to increase resectability rates by inducing a hypertrophy of the future liver remnant.2,3,12,13,23,25 The hypertrophy rates observed after 4–12 weeks following PVE or PVL vary and usually range from about 20 to 40 %, but reach almost 60–70 % in highly specialized centers. However, PVE and PVL may not only induce liver hypertrophy but also tumor growth, and thus, the time between PVE/PVL and liver resection required to achieve sufficient growth of the FLR bears the risk of tumor progression.7,13,23 This has been shown in several studies where in up to 25–30 % of patients scheduled for hepatectomy following PVL/PVE and/or staged hepatectomy complete tumor resection could not be achieved due to tumor progression before step 2.7,13,23 …