Associating liver partition and portal vein ligation for staged hepatectomy procedure versus conventional two-stage hepatectomy for colorectal liver metastasis.

In 30 seconds

This Cochrane systematic review and meta-analysis assessed ALPPS versus conventional two-stage hepatectomy in adults with colorectal liver metastases and an estimated future liver remnant below 30% of total liver volume. Only one six-centre randomised trial, involving 100 participants, met the criteria, so the review did not pool results. At maximum follow-up of 93 months, ALPPS probably made little to no difference in all-cause mortality compared with two-stage hepatectomy (RR 0.86, 95% CI 0.72 to 1.03; 97 participants; moderate-certainty evidence).

Key findings

• At 90 days, perioperative all-cause mortality showed little to no difference between procedures (RR 1.36, 95% CI 0.32 to 5.76; 97 participants; low-certainty evidence).
• At maximum follow-up of 93 months, all-cause mortality probably differed little between ALPPS and conventional two-stage hepatectomy (RR 0.86, 95% CI 0.72 to 1.03; 97 participants).
• The trial reported mean quality-adjusted survival of 1.25 QALY with ALPPS and 1.11 QALY with two-stage hepatectomy; the abstract’s confidence interval for the comparator result is incomplete.

Why it matters

For patients with extensive colorectal liver metastases and a small future liver remnant, the choice between these staged approaches involves balancing liver growth and the possibility of completing resection against serious harms and longer-term outcomes. This review indicates that comparative mortality evidence is limited to one trial, with no clear mortality advantage established for either procedure.

What to keep in mind

Only one randomised trial with 97 participants contributing to the reported mortality analyses met the review criteria, preventing meta-analysis. Certainty was low for 90-day mortality and moderate for mortality at maximum follow-up.