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Case-Based Lessons in the Management of Complex Hepato-Pancreato-Biliary Surgery pp 57–71Cite as

Management of Patients with Bilateral Multifocal Colorectal Liver Metastases: ALPPS

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Abstract

At diagnosis, 15–25% of patients with stage IV colon cancer have synchronous detected liver metastases. About 30% of patients are not initially resectable due to the extent of hepatic disease or a small future liver remnant (FLR). When size of FLR is regarded to be not sufficient to sustain liver function in the postoperative course, techniques of portal vein occlusion (PVO) such as portal vein embolization (PVE) or portal vein ligation (PVL) can be used in the context of a classic two-stage hepatectomy (TSH) to get increase of the residual liver. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel two-stage technique which combines PVO and parenchymal transection, followed by hepatectomy in a shorter period of time than classical TSH. However, many concerns have been addressed to the safety of this procedure. Further refinements of the original technique have been explored to improve its results. We report herein the case of a 44-year-old female patient with an obstructive cancer of the sigmoid colon and synchronous bilateral colorectal liver metastases, treated with the so-called “mini-ALPPS” approach.

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Authors and Affiliations

  1. Department of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina

    Matteo Serenari, Martin de Santibañes, Victoria Ardiles & Eduardo de Santibañes

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  1. Matteo Serenari
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  2. Martin de Santibañes
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  3. Victoria Ardiles
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  4. Eduardo de Santibañes
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Correspondence to Eduardo de Santibañes .

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Editors and Affiliations

  1. The Ohio State Wexner Medical Center , The Ohio State University School of Medicine , Columbus, Ohio, USA

    Timothy M. Pawlik

  2. Division of General Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA

    Sharon Weber

  3. Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    T. Clark Gamblin

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Serenari, M., de Santibañes, M., Ardiles, V., de Santibañes, E. (2017). Management of Patients with Bilateral Multifocal Colorectal Liver Metastases: ALPPS. In: Pawlik, T., Weber, S., Gamblin, T. (eds) Case-Based Lessons in the Management of Complex Hepato-Pancreato-Biliary Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-50868-9_5

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