Background : ALPPS is effective treatment modality for CCLM(colon caner liver metastasis). However following procedure, we worry the patient safety especially postoperative liver failure.

Methods : Sixty two year old male patient was admitted to our department for ALPPS and anterior resection due to sigmoid colon cancer with multiple liver metastasis after 13 cylcles of chemotherapy. After four weeks rest he underwnt anterior resection, cholecystectomy, multiple wedge resection of for left lobe metastatic foci, right portal vein ligation, parenchymal dissection through right trisectionectomy plane, taping right hepatic vein and right portal triad respectively. Seven days later second operation such as complete right trisectionectomy was done. Postoperative course is uneventful except progressive jaundice (20.2 mg/L.) with peak level on one month after second operation. And then total bilirubin level was normalized to 0.8 for about 7 months. But, he had no abnormal clinical symptom and was not reuqired no change in the clinical management.

Results : We have followed patient with no evidence of caner recurrence for one year.

Conclusions : RLM with a low future remnant liver volume is considered a good indication for ALPPS. However, estimating the risk factor such as Future liver remnant (FLR), neoadjuvant chemotherapy, fibrosis grade before surgery is important to prevent posthepatectomy liver failure.