Liver venous deprivation (LVD) or ALPPS in the treatment of colorectal liver metastasis (CRLM): a comparison of oncological outcome.

BACKGROUND

Patients with a high metastatic tumor burden may be candidates for extensive liver resection with a liver augmentation technique. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) are the most effective techniques for stimulating liver growth. However, postoperative and oncological outcomes of these approaches require further clarification in large cohorts. This study assessed the oncological outcomes of patients treated for colorectal liver metastases (CRLM) using ALPPS or LVD.

METHODS

All consecutive patients who underwent LVD and/or ALPPS for CRLM at eight French centers between 2011 and 2022 were included in a retrospective database. The primary endpoint was oncological outcomes according to the intention-to-treat principle. Secondary endpoints included the resection rate, intraoperative and postoperative outcomes, and a per-protocol analysis excluding patients requiring rescue ALPPS after LVD failure.

RESULTS

In total, 214 patients with CRLM were included from the eight centers; 127 (59.3 %) underwent LVD and 87 (40.7 %) underwent ALPPS. Resectability rates, based on the intention-to-treat principle, were 84.3 % (n = 107) in the LVD group and 98.9 % (n = 86) in the ALPPS group. In the intention-to-treat analysis, median overall survival durations were 42 months in the LVD group and 30 months in the ALPPS group. Median disease-free survival durations were 7 months in the LVD group and 6 months in the ALPPS group.

CONCLUSION

Overall and disease-free survival did not substantially differ between LVD and ALPPS prior to major liver resection for CRLM. This study represents the largest comparison of postoperative and oncological outcomes between LVD and ALPPS in patients with CRLM; it may serve as a foundation for a randomized controlled trial.