Safety and efficacy of total laparoscopic ALPPS for colorectal liver metastasis

doi:10.3877/cma.j.issn.2095-3232.2025.05.013

Abstract

Abstract:

Objective

To evaluate perioperative safety and efficacy of total laparoscopic ALPPS in the treatment of colorectal liver metastasis (CRLM).

Methods

Clinical data of 12 patients with CRLM treated with total laparoscopic ALPPS in the Sixth Affiliated Hospital of Sun Yat-sen University from April 2021 to April 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 7 patients were male and 5 female, aged from 40 to 70 years, with a median age of 56 years. 11 cases were diagnosed with synchronous liver metastases and 1 case of metachronous liver metastasis. 5 patients had liver metastases in left and right lobes, 5 cases in the right lobe, and 2 cases in bilateral lobes and caudate lobe, respectively. The maximum diameter of liver metastases was 6.5 cm. Perioperative bleeding loss, incidence of complications and postoperative recovery were observed.

Results

Among 12 patients undergoing total laparoscopic ALPPS, 1 case received simultaneous resection of liver and intestinal lesions, and 11 cases underwent staged resections. After primary and secondary ALPPS, transaminase levels peaked at postoperative 1-2 d, and then gradually declined. After primary and secondary ALPPS, total bilirubin levels were not significantly increased and maintained within 2 times of normal value. The median amount of bleeding during primary laparoscopic ALPPS was 100 (50-600) ml. 2 patients developed postoperative complications, including 1 case of pleural effusion and biliary fistula and 1 case of cardiac insufficiency, all of which were classified as Clavien-Dindo grade Ⅲa. No patient died after surgery. The median amount of bleeding during secondary laparoscopic ALPPS was 125 (50-1 000) ml. 7 cases suffered from postoperative complications, including pleural effusion, biliary fistula, poor wound healing, cardiac insufficiency and jaundice. 4 patients had Clavien-Dindo grade Ⅲa complications, and no Clavien-Dindo grade Ⅲb or above complications were reported. No patient died within postoperative 90 d.

Conclusion

Total laparoscopic ALPPS is a safe and feasible treatment for CRLM, which provides a radical resection opportunity for unresectable CRLM.

Key words: Laparoscopy, Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS), Colorectal liver metastasis

Zheyu Zheng, Lei Zhang, Dawei Zhang, Weidong Pan, Xiaoming Huang. Safety and efficacy of total laparoscopic ALPPS for colorectal liver metastasis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(05): 748-753.

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References 30

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