ALPPS Improves Resectability Compared with Conventional Two-stage Hepatectomy in Patients with Advanced Colorectal Liver Metastasis: Results from a Scandinavian Multicenter Randomized Controlled Trial (LIGRO Trial)

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Objective: The aim of the study was to evaluate if associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) could increase resection rates (RRs) compared with two-stage hepatectomy (TSH) in a randomized controlled trial (RCT). Background: Radical liver metastasis resection offers the only chance of a cure for patients with metastatic colorectal cancer. Patients with colorectal liver metastasis (CRLM) and an insufficient future liver remnant (FLR) volume are traditionally treated with chemotherapy with portal vein embolization or ligation followed by hepatectomy (TSH). This treatment sometimes fails due to insufficient liver growth or tumor progression. Methods: A prospective, multicenter RCT was conducted between June 2014 and August 2016. It included 97 patients with CRLM and a standardized FLR (sFLR) of less than 30%. Primary outcome - RRs were measured as the percentages of patients completing both stages of the treatment. Secondary outcomes were complications, radicality, and 90-day mortality measured from the final intervention. Results: Baseline characteristics, besides body mass index, did not differ between the groups. The RR was 92% [95% confidence interval (CI) 84%-100%] (44/48) in the ALPPS arm compared with 57% (95% CI 43%-72%) (28/49) in the TSH arm [rate ratio 8.25 (95% CI 2.6-26.6); P < 0.0001]. No differences in complications (Clavien-Dindo ≥3a) [43% (19/44) vs 43% (12/28)] [1.01 (95% CI 0.4-2.6); P = 0.99], 90-day mortality [8.3% (4/48) vs 6.1% (3/49)] [1.39 [95% CI 0.3-6.6]; P = 0.68] or R0 RRs [77% (34/44) vs 57% (16/28)] [2.55 [95% CI 0.9-7.1]; P = 0.11)] were observed. Of the patients in the TSH arm that failed to reach an sFLR of 30%, 12 were successfully treated with ALPPS. Conclusion: ALPPS is superior to TSH in terms of RR, with comparable surgical margins, complications, and short-term mortality.


  • Per Sandström
  • Bard I. Røsok
  • Ernesto Sparrelid
  • Peter N. Larsen
  • Anna L. Larsson
  • Gert Lindell
  • Nicolai A. Schultz
  • Bjorn A. Bjørnbeth
  • Bengt Isaksson
  • Magnus Rizell
  • Bergthor Björnsson
External organisations
  • Linköping University
  • Oslo university hospital
  • Karolinska University Hospital
  • University of Copenhagen
  • Skåne University Hospital
  • University of Gothenburg
  • Karolinska Institutet
  • Copenhagen University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Surgery


  • associating liver partition and portal vein ligation for staged hepatectomy, colorectal liver metastasis, portal embolization, portal ligation, RCT, two-stage hepatectomy
Original languageEnglish
Pages (from-to)833-840
Number of pages8
JournalAnnals of Surgery
Issue number5
Publication statusPublished - 2018 May 1
Publication categoryResearch

Related research output

Per Sandström, Bård I. Rösok, Ernesto Sparrelid, Gert Lindell, Peter Nörgaard Larsen, Anna Lindhoff Larsson, Nicolai A. Schultz, Bengt Isaksson, Magnus Rizell & Bergthor Björnsson, 2018, In : Annals of Surgery. 268, 6, p. e83-e85

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