Colorectal cancer in the liver: a faster surgery lets more people have tumors removed

If colorectal cancer has spread to your liver, or a loved one’s has, here is some good news. A faster staged surgery called ALPPS lets many more people get all of their tumors removed than the standard two-step operation does. Survival over the long run looked similar for both.

That matters because removing the tumors is what gives people a real chance at long-term control. For some, the barrier is simple. After surgery, there might not be enough healthy liver left to keep them well. ALPPS is a way around that barrier.

How the study worked

This was a Cochrane review, which gathers and weighs the best trials on a question. The reviewers searched widely through December 4, 2025, and found one trial that fit: a publicly funded trial at six Scandinavian centers with 100 adults whose cancer had spread to the liver. Their remaining liver was expected to be less than 30% of the total, too small for a standard operation. The review appeared in the Cochrane Database of Systematic Reviews on October 27, 2026. Because it rests on a single trial, more studies will help sharpen the picture.

What are the two surgeries?

Both operations work because the liver can regrow. In the standard two-stage surgery, surgeons remove some tumors and block blood flow to part of the liver. Then they wait for the healthy part to grow before a second operation.

ALPPS, short for associating liver partition and portal vein ligation for staged hepatectomy, also divides the liver in the first operation. That makes the healthy part grow faster and larger.

What they found

The biggest difference was in how many people got to the finish line. People assigned to ALPPS were much more likely to have their tumors fully removed within eight weeks (a risk ratio of 1.60 in the abstract). The reviewers rated this as a large increase, with moderate certainty.

Survival was a similar story, and that is good news too. Getting more people through surgery did not come at the cost of how long they lived.

The follow-up was long. The median was 93 months. For overall survival, the abstract reports a hazard ratio of 0.72, which points in ALPPS’s favor, though the reviewers call it little to no difference. For quality of life and serious side effects in the first 30 days, the evidence was too thin to say either way.

What you can do today

If you or someone close to you has colorectal cancer in the liver and has been told surgery is not possible because too little healthy liver would remain, write down one question for the next visit: “Is a staged surgery, including ALPPS, an option for me at a specialized liver surgery center?” Bring it to the appointment, and ask for a second opinion if you would like one. Many large cancer centers have liver surgery teams, and your insurance or Medicare plan can tell you which ones are covered.