Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2025; 31(18): 105530
Published online May 14, 2025. doi: 10.3748/wjg.v31.i18.105530
Laparoscopic associating liver partition and portal vein ligation for staged hepatectomy for colorectal liver metastases: A single-center experience
Zhe-Yu Zheng, Lei Zhang, Wen-Li Li, Shu-Yi Dong, Jing-Lin Song, Da-Wei Zhang, Xiao-Ming Huang, Wei-Dong Pan
Zhe-Yu Zheng, Lei Zhang, Shu-Yi Dong, Jing-Lin Song, Da-Wei Zhang, Xiao-Ming Huang, Wei-Dong Pan, Department of Pancreatic Hepatobiliary Surgery, Department of General Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Zhe-Yu Zheng, Lei Zhang, Wen-Li Li, Shu-Yi Dong, Jing-Lin Song, Da-Wei Zhang, Xiao-Ming Huang, Wei-Dong Pan, Biomedical Innovation Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Wen-Li Li, Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Co-corresponding authors: Xiao-Ming Huang and Wei-Dong Pan.
Author contributions: Zheng ZY, Zhang L, Li WL, Dong SY, and Song JL contributed to acquisition of data, analysis and interpretation of data, drafting of the manuscript, and statistical analysis; Zhang DW, Huang XM, and Pan WD contributed to study concept and design, obtained funding and material support, study supervision and critical revision of the manuscript for important intellectual content; and all authors of this research have approved the final version of the article. Zhang DW, Huang XM, and Pan WD contributed equally to this work, Huang XM and Pan WD as the co-corresponding authors of this manuscript.
Supported by Natural Science Foundation of Guangdong Province of China, No. 2024A1515012862.
Institutional review board statement: Data collection for this study was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University (Approval No. 2022ZSLYEC-130).
Informed consent statement: Informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Dong Pan, MD, Chief Physician, Professor, Department of Pancreatic Hepatobiliary Surgery, Department of General Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, No. 26 Erheng Road, Tianhe District, Guangzhou 510655, Guangdong Province, China. panwd@mail.sysu.edu.cn
Received: January 27, 2025
Revised: February 27, 2025
Accepted: April 24, 2025
Published online: May 14, 2025
Processing time: 107 Days and 7.6 Hours
Abstract
BACKGROUND

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a procedure used for patients with initially unresectable colorectal liver metastases (CRLM). However, the procedure has been reported to be associated with high morbidity and mortality. Laparoscopic ALPPS has recently been reported as a minimally invasive technique that reduces perioperative risks.

AIM

To assess the safety and feasibility of full laparoscopic ALPPS in patients with CRLM.

METHODS

A retrospective analysis was conducted on all consecutive patients with CRLM who underwent full laparoscopic ALPPS at the Sixth Affiliated Hospital of Sun Yat-sen University between March 2021 and July 2024.

RESULTS

Fifteen patients were included, 13 with synchronous liver metastases. Nine patients had more than five liver tumors, with the highest count being 22. The median diameter of the largest lesion was 2.8 cm on preoperative imaging. No extrahepatic metastases were observed. RAS mutations were detected in nine patients, and 14 underwent preoperative chemotherapy. The median increase in future liver remnant volume during the interstage interval was 47.0%. All patients underwent R0 resection. Overall complication rates were 13.3% (stage 1) and 53.3% (stage 2), while major complication rates (Clavien-Dindo ≥ IIIa) were 13.3% (stage 1) and 33.3% (stage 2). No mortality occurred in either stage. The median hospital stay after stage 2 was 10 days.

CONCLUSION

Full laparoscopic ALPPS for CRLM is safe and feasible, with the potential for reduced morbidity and mortality, offering radical resection opportunities for patients with initially unresectable CRLM.

Keywords: Minimally invasive surgery; Laparoscopic surgery; Associating liver partition and portal vein ligation for staged hepatectomy; Colorectal liver metastases; Future liver remnant

Core Tip: This study evaluates the feasibility and safety of full laparoscopic associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in colorectal liver metastases. Among 15 patients, the procedure achieved a 100% radical resection rate with significant future liver remnant hypertrophy (47% median increase). Complication rates were low, particularly in stage 1, with no mortality reported. Laparoscopic modifications minimized invasiveness and enhanced surgical outcomes. Post-ALPPS liver regeneration was substantial, demonstrating the potential for repeat interventions. These findings support full laparoscopic ALPPS as a promising strategy for advanced colorectal liver metastases, addressing the limitations of traditional hypertrophy techniques like portal venous embolization or portal venous ligation.