ORIGINAL SCIENTIFIC REPORT Long-Term Outcome After Conventional Two-Stage Hepatectomy Versus Tourniquet-ALPPS in Colorectal Liver Metastases: A Propensity Score Matching Analysis Ricardo Robles-Campos 1,4 • Roberto Brusadin 1 • Asuncio ´n Lo ´pez-Conesa 1 • Vı ´ctor Lo ´pez-Lo ´pez 1 • A ´ lvaro Navarro-Barrios 1 • Jose ´ J. Lo ´pez-Espı ´n 2 • Julio Are ´valo-Pe ´rez 3 • Pascual Parrilla 1 Ó Socie ´te ´ Internationale de Chirurgie 2019 Abstract Background To compare the overall survival (OS) and disease-free survival (DFS) of Tourniquet-ALPPS (T- ALPPS) and conventional two-stage hepatectomy (TSH) in patients with colorectal liver metastases (CRLM). Methods A retrospective study from a prospectively collected database was performed between October 2000 and July 2016. TSH was performed before September 2011, after which time T-ALPPS became the technique of choice. A propensity score matching (PSM) was performed based on a 1:1 ratio with consideration of the following variables: number and size of metastases, bilobar disease presence, and chemotherapy received. Results Thirty-four patients received T-ALPPS; 41 patients received TSH. After PSM, 21 patients remained in each group, with 100% resectability in the T-ALPPS group and 90.5% resectability in the TSH group. The median OS for TSH was 41 months; for T-ALPPS, the median OS was 36 months (P = 0.925). The median DFS was 16 months in the TSH group; the median DFS was 9 months in the T-ALPPS group (P = 0.930). The 1-, 3-, and 5-year OS for TSH was 81%, 66.7%, and 23.8% vs. 76.2%, 57.1%, and 22.9% for T-ALPPS, respectively. The 1-, 3-, and 5-year DFS for TSH was 66.7%, 9.5%, and 5% vs. 44.6%, 11.1%, and 11.1% for T-ALPPS, respectively. The volume increase with T-ALPPS was superior to that with TSH (68% vs. 39%; P = 0.018). There were no differences in morbidity and mortality after stages 1 and 2. Conclusions T-ALPPS produces a similar outcome to TSH, indicating that it could be a safe and effective alternative for curative hepatectomy for all patients. Introduction Liver resection offers a chance of cure for patients with colorectal liver metastases (CRLM) [1, 2]. Only 15–30% of patients are initially candidates for surgery [1]. In this setting, a multidisciplinary strategy that includes new chemotherapeutic agents has enabled resection for a remarkable percentage of patients [3, 4]. Liver regeneration techniques have also increased the number of patients who are suitable for surgery, since hypertrophy that occurs in the future liver remnant (FLR) could prevent post-hepatectomy liver failure (PHLF). The first hypertrophy technique was portal vein embolization (PVE) [5]; Rene ´ Adam et al. [6] later introduced the two- & Ricardo Robles-Campos rirocam@um.es 1 Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain 2 Miguel Hernandez University, Elche, Alicante, Spain 3 Radiology Department, Memorial Sloan Kettering Cancer Center, New York, USA 4 Department of Surgery, Virgen de La Arrixaca Clinic, University Hospital, El Palmar, Murcia, Spain 123 World J Surg https://doi.org/10.1007/s00268-019-05031-w