STAGED LIVER RESECTION USING ALPPS TECHNOLOGY: AN INNOVATIVE SURGICAL TECHNIQUE FOR THE TREATMENT OF MULTIPLE COLORECTAL LIVER METASTASES

Introduction. Postoperative acute liver failure is a life-threatening companion of extensive liver resection in patients with colorectal liver metastases. A surgical technique called Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has been proposed to induce hyperplasia of the planned liver remnant. Aim. The aim of the study is to analyze our own clinical experience of staged liver resection using the ALPPS technique in the complex surgical treatment of multiple colorectal liver metastases to the liver and compare it with other authors’ results. Materials and Methods. In this clinical observation, two-stage liver resection using the ALPPS technique was successfully used in the complex treatment of a male patient with multiple liver metastases of low-differentiated sigmoid colon adenocarcinoma, stage IIIA (T2N1M0). Upon prior chemotherapy, the planned liver remnant volume was less than 25%. Results and Discussion. Duration of the first stage of surgery was 210 minutes, and intraoperative blood loss was 450 ml. By the eighth day of the postoperative period, the volume of the planned liver remnant increased by 9%, reaching 38%. The second stage of intervention was performed nine days after the first one. Its duration was 75 minutes, and blood loss was 150 ml. On the 16th day after the second stage of the surgery, the patient was discharged from the hospital in satisfactory condition. A control CT scan performed three months after discharge revealed a 54% increase in the liver remnant compared to its initial size and no new metastatic foci. The patient subsequently received adjuvant polychemotherapy. Unfortunately, 31 months after performing the ALPPS surgery, the patient died. The death was caused by cancer recurrence. Conclusions. The presented clinical observation demonstrates the successful and complete completion of extensive bilobar liver resection with achievement of R0-resection in a patient with multiple colorectal liver metastases. Despite the favorable surgical outcome, cancer recurrence was fatal.