The ALPPS procedure as a novel "liver-first" approach in treating liver metastases of colon cancer: the first experience in Greek Cypriot area.

Journal Article (Journal Article)


Despite recent advances in multimodality and multidisciplinary treatment of colorectal liver metastases, many patients suffer from extensive bilobar disease, which prevents the performance of a single procedure due to an insufficient future liver remnant (FLR). We present a novel indication for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as a "liver-first" approach when inadequate FLR was faced preoperatively, in a patient with extensive bilobar liver metastatic disease of colon cancer origin.

Case presentation

A 51-year-old lady was referred to our center due to a stage IV colon cancer with extensive bilobar liver disease and synchronous colon obstruction. During the multidisciplinary tumor board, it was recommended to proceed first in a palliative loop colostomy (at the level of transverse colon) operation and afterwards to offer her palliative chemotherapy. After seven cycles of chemotherapy, the patient was re-evaluated by CT scans that revealed an excellent response (>30%), but the metastatic liver disease was still considered inoperable. Moreover, with the completion of 12 cycles, the indicated restaging process showed further response. Subsequent to a thorough review by the multidisciplinary team, it was decided to proceed to the ALPPS procedure as a feasible means to perform extensive or bilobar liver resections, combined with a decreased risk of tumor progression in the interim.


All in all, ALPPS can offer a feasible but surgically demanding liver-first approach with satisfactory short-term results in selected patients. Larger studies are mandatory to evaluate short- and long-term results of the procedure on survival, morbidity, and mortality.

Full Text

Duke Authors

Cited Authors

  • Petrou, A; Moris, D; Kountourakis, P; Fard-Aghaie, M; Neofytou, K; Felekouras, E; Papalampros, A

Published Date

  • March 8, 2016

Published In

Volume / Issue

  • 14 /

Start / End Page

  • 67 -

PubMed ID

  • 26956733

Pubmed Central ID

  • PMC4782321

Electronic International Standard Serial Number (EISSN)

  • 1477-7819

International Standard Serial Number (ISSN)

  • 1477-7819

Digital Object Identifier (DOI)

  • 10.1186/s12957-016-0827-3


  • eng