Laparoscopic associating liver partition and portal vein ligation for staged hepatectomy for colorectal liver metastases: A single-center experience

Table 1 Demographic and tumor characteristics, n (%)

Variable		Overall (n = 15)
Age, years		57 (37-70)
Gender	Male	8 (53.3)
	Female	7 (46.7)
BMI, kg/m2		22.0 (18.6-26.2)
ASA score	2	14 (93.3)
	3	1 (6.7)
Primary tumor
Location	Left	7 (46.7)
	Right	6 (40.0)
	Bilateral	2 (13.3)
Primary tumor resected		11 (73.3)
Liver metastases
Timing of liver metastases	Synchronous	13 (86.7)
	Metachronous	2 (13.3)
Number of tumors	1-5	6 (40.0)
	6-10	4 (26.7)
	11-20	4 (26.7)
	> 20	1 (6.7)
Bilobar disease		8 (53.3)
Max tumor size, mm		2.8 (1.4-6.5)
MHV involvement		7 (46.7)
RAS mutation		9 (60.0)
CEA before ALPPS, ng/mL		9.1 (2.0-179.2)
CRS	2	5 (33.3)
	3	8 (53.3)
	4	2 (13.3)
CAPRA score		2.48 (0.7-4.54)
Extrahepatic metastases		0 (0.0)
Chemotherapy1
Preoperative chemotherapy		14 (93.3)
Cycles of chemotherapy		8 (1-30)
Chemotherapy response	PR	7 (50.0)
	SD	3 (21.4)
	PD	4 (28.6)

¹One patient did not receive preoperative chemotherapy.

BMI: Body mass index; ASA: American Society of Anesthesiologists; MHV: Middle hepatic vein; CEA: Carcinoembryonic antigen; ALPPS: Associated liver partition and portal vein ligation for staged hepatectomy; CRS: Fong’s clinical risk score; CAPRA: Comprehensive associated liver partition and portal vein ligation for staged hepatectomy preoperative risk assessment; PR: Partial response; SD: Stable disease; PD: Progressive disease.

Table 2 Surgery characteristics, n (%)

Variable		Overall (n = 15)
Stage 1 of ALPPS
Associated procedures	Concomitant colorectal resection	1 (6.7)
	Ablation in FLR	3 (20.0)
	Resection and ablation in FLR	4 (26.7)
Operation time, minute		255 (170-430)
Blood loss, mL		100 (50-600)
Blood transfusion		1 (6.7)
Conversion to open		0 (0.0)
Interstage interval, days		17 (13-24)
Stage 2 of ALPPS
Type of hepatectomy	Right hepatectomy	8 (53.3)
	Extended right hepatectomy	7 (46.7)
Resection/ablation in FLR		0 (0.0)
Operation time, minute		195 (171-409)
Blood loss, mL		100 (20-1000)
Blood transfusion		2 (13.3)
Conversion to open		0 (0.0)
R0 resection		15 (100.0)

ALPPS: Associating liver partition and portal vein ligation for staged hepatectomy; FLR: Future liver remnant; R0: Microscopically radical liver resection.

Table 3 Volumetric characteristics

Variable	Overall (n = 15)
FLR pre stage 1, mL	356.0 (202.6-458.3)
FLR/sTLV pre stage 1, %	33.3 (17.8-41.2)
FLR pre stage 2, mL	478.1 (380.9-642.3)
FLR/sTLV pre stage 2, %	41.5 (33.4-57.8)
Increase volume, mL	173.9 (30.7-247.8)
Increase rate, %	47.0 (7.5-97.3)
Time between stage 1 and imaging, days	10 (8-21)
Increased velocity, mL/day	11.2 (3.4-26.6)

FLR: Future liver remnant; sTLV: Standardized total liver volume.

Table 4 Postoperative characteristics, n (%)

Variable		Overall (n = 15)
Stage 1 of ALPPS
Complication type	Total	2 (13.3)
	Pleural effusion	2 (13.3)
	Ascites	2 (13.3)
	Biliary fistula	1 (6.7)
	Cardiac insufficiency	1 (6.7)
Complication grade	Minor (Clavien-Dindo 1-2)	1 (6.7)
	Major (Clavien-Dindo 3-5)	2 (13.3)
CCI score		0.0 (0.0-50.0)
Mortality		0 (0.0)
Stage 2 of ALPPS
Complication type	Total	8 (53.3)
	Wound infection	2 (13.3)
	Pleural effusion	3 (20.0)
	Ascites	2 (13.3)
	Biliary fistula	3 (20.0)
	PHLF (ISGLS grade A)	1 (6.7)
	Cardiac insufficiency	1 (6.7)
Complication grade	Minor (Clavien-Dindo 1-2)	4 (26.7)
	Major (Clavien-Dindo 3-5)	5 (33.3)
CCI score		8.7 (0.0-45.4)
Mortality		0 (0.0)
Hospital stay after stage 2, days		10 (5-26)

ALPPS: Associating liver partition and portal vein ligation for staged hepatectomy; CCI: Comprehensive complications index; PHLF: Post-hepatectomy liver failure; ISGLS: International Study Group of Liver Surgery.