Zheng Zhe-Yu, Zhang Lei, Li Wen-Li, Dong Shu-Yi, Song Jing-Lin, Zhang Da-Wei, Huang Xiao-Ming, Pan Wei-Dong
Department of Pancreatic Hepatobiliary Surgery, Department of General Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China.
Biomedical Innovation Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China.
World J Gastroenterol. 2025 May 14;31(18):105530. doi: 10.3748/wjg.v31.i18.105530.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a procedure used for patients with initially unresectable colorectal liver metastases (CRLM). However, the procedure has been reported to be associated with high morbidity and mortality. Laparoscopic ALPPS has recently been reported as a minimally invasive technique that reduces perioperative risks.
To assess the safety and feasibility of full laparoscopic ALPPS in patients with CRLM.
A retrospective analysis was conducted on all consecutive patients with CRLM who underwent full laparoscopic ALPPS at the Sixth Affiliated Hospital of Sun Yat-sen University between March 2021 and July 2024.
Fifteen patients were included, 13 with synchronous liver metastases. Nine patients had more than five liver tumors, with the highest count being 22. The median diameter of the largest lesion was 2.8 cm on preoperative imaging. No extrahepatic metastases were observed. RAS mutations were detected in nine patients, and 14 underwent preoperative chemotherapy. The median increase in future liver remnant volume during the interstage interval was 47.0%. All patients underwent R0 resection. Overall complication rates were 13.3% (stage 1) and 53.3% (stage 2), while major complication rates (Clavien-Dindo ≥ IIIa) were 13.3% (stage 1) and 33.3% (stage 2). No mortality occurred in either stage. The median hospital stay after stage 2 was 10 days.
Full laparoscopic ALPPS for CRLM is safe and feasible, with the potential for reduced morbidity and mortality, offering radical resection opportunities for patients with initially unresectable CRLM.
联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）是用于治疗最初不可切除的结直肠癌肝转移（CRLM）患者的一种手术方法。然而，据报道该手术的发病率和死亡率较高。最近有报道称腹腔镜ALPPS是一种可降低围手术期风险的微创技术。
评估全腹腔镜ALPPS治疗CRLM患者的安全性和可行性。
对2021年3月至2024年7月在中山大学附属第六医院接受全腹腔镜ALPPS的所有连续性CRLM患者进行回顾性分析。
纳入15例患者，其中13例为同时性肝转移。9例患者有5个以上肝肿瘤，最多达22个。术前影像学检查显示最大病灶的中位直径为2.8 cm。未观察到肝外转移。9例患者检测到RAS突变，14例接受了术前化疗。分期间隔期间未来肝脏残余体积的中位增加率为47.0%。所有患者均接受了R0切除。总体并发症发生率在第1阶段为13.3%，在第2阶段为53.3%，而严重并发症发生率（Clavien-Dindo≥Ⅲa级）在第1阶段为13.3%，在第2阶段为33.3%。两个阶段均未发生死亡。第2阶段后的中位住院时间为10天。
全腹腔镜ALPPS治疗CRLM安全可行，有可能降低发病率和死亡率，为最初不可切除的CRLM患者提供根治性切除机会。
