Ann Hepatobiliary Pancreat Surg.  2020 Nov;24(4):522-525. 10.14701/ahbps.2020.24.4.522.

Monosegment ALPPS for bilateral colorectal liver metastasis - One is enough

• Steinbrück K
• Fernandes R
• Stoduto G
• Auel T

• KMID: 2508863
• DOI: http://doi.org/10.14701/ahbps.2020.24.4.522

Abstract

Associated liver partition and portal vein ligation for staged hepatectomy – ALPPS – procedure emerged as an alternative to treat patients needing extensive hepatic resections, but with a small future liver remnant. Initially described using the left lateral segments as liver remnant, ALPPS has been adapted to leave as remainder only one segment. Describe a case of a patiente with bilobar colorectal liver metastasis submitted to segment 4-1 ALPPS. A 63-year-old man, previously submitted to transversostomy, due to a left colon stenosing adenocarcinoma, associated to bilobar liver metastasis, was referred for our evaluation, after receiving a FOLFOX based chemotherapy. Due to the large load of tumor within the liver, we opted to perform a segment 4-1 ALPPS, which was carried out with an interval of 21 days between first and second stages. The liver remnant increased from 250 cc to 694 cc (18% to 48% of standard liver volume). The patient was discharged 15 days after second stage surgery and was subjected to left colectomy after five months. He is disease-free ten months after liver surgery. Monosegment ALPPS is a challenging, but feasible procedure, that should be criteriously indicated in selected patients and performed by a hepatobiliary surgery team with experience in complex major hepatectomies.

Keyword

Liver; Surgery; Metastasis; Colorectal neoplasms; Surgical oncology

Figure

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  Fig. 1 (A) CT scan before chemotherapy; (B) MRI scan after chemotherapy; in both images, you can see lesions in the right liver (*), in the left lateral section (#) and in segment 4 (arrow- head).

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  Fig. 2 (A) Right portal vein was ligated with hem-o-lok clips (arrow); (B) right hepatic vein encircled with white tape; (C) final aspect of the liver after 1st stage surgery; right hilar plate encircled with yellow tape; right hepatic artery (not seen) encircled with red tape.

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  Fig. 3 (A) Segment 4 of the liver before ALPPS; (B) segment 4 of the liver after 1st stage surgery, showing expressive hypertrophy.

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