Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.814
Peer-review started: February 9, 2021
First decision: May 13, 2021
Revised: May 24, 2021
Accepted: July 13, 2021
Article in press: July 13, 2021
Published online: August 27, 2021
Colorectal cancer (CRC) is a common malignancy of the digestive system. Colorectal liver cancer metastasis (CRLM) occurs in approximately 50% of the patients and is the main cause of CRC mortality. Surgical resection is currently the most effective treatment for CRLM. However, given that the remnant liver volume after resection should be adequate, only a few patients are suitable for radical resection. Since Dr. Hans Schlitt first performed the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for CRLM in 2012, ALPPS has received considerable attention and has continually evolved in recent years. This review explains the technical origin of the ALPPS procedure for CRLM and evaluates its efficacy, pointing to its favorable postoperative outcomes. We also discuss the patient screening strategies and optimization of ALPPS to ensure long-term survival of patients with CRLM in whom surgery cannot be performed. Finally, further directions in both basic and clinical research regarding ALPPS have been proposed. Although ALPPS surgery is a difficult and high-risk technique, it is still worth exploration by experienced surgeons.
Core Tip: Several previous reviews have discussed the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique and its applications. However, this is the first review on ALPPS in colorectal liver cancer metastasis, in which the technical evolution of the procedure is described, its safety and efficacy are evaluated, patient selection process and technique improvement are discussed, and further directions are proposed.