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Is ALPPS a feasible alternative for patients with otherwise unresectable colorectal liver metastases?

Joost Huiskens, Thomas M. van Gulik, Eduardo de Santibanes (PI)
Department / Institution: 
Department of Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Date Project Approved: 
Monday, 27 July, 2015
Project Status: 
ALPPS has redefined resectability for patients with colorectal liver metastases (CRLM), however the oncological outcomes remain controversial. The indication for ALPPS is currently unclear. The technique is used as a replacement for a conventional two-stage procedure, as well as to be able to resect patients with disease considered unresectable. The latter indication would provide a curative potential for a group of patients that would otherwise only be eligible for systemic therapy. However, the oncological outcomes of these patients with advanced disease need to be examined
The primary objective is to compare progression-free survival in patients after ALPPS versus after systemic chemotherapy. The secondary objective is to assess ALPPS related morbidity and mortality and to compare overall survival in both groups.
Patients with otherwise unresectable CRLM who underwent ALPPS will be selected from the international ALPPS registry and compared to unresectable patients from the CAIRO3 database treated with systemic therapy. Case-matched analysis will be performed with propensity score analysis. Primary outcome is progression-free survival. ALPPS is commonly used as an alternative for two-stage hepatectomy. However, this technique is also proposed for patients with otherwise unresectable disease. The latter raises serious oncological concerns. In view of the lack of consensus regarding the indications for ALPPS, the oncological outcome following ALPPS for patients with otherwise unresectable CRLM needs to be defined.


University Hospital Zurich
Department of Surgery
Raemistrasse 100
8091 Zurich, Switzerland


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