Early survival and safety of ALPPS: first report of the International ALPPS Registry

To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry. ALPPS induces accelerated growth of small future liver remnants (FLR) to allow curative resection of liver tumors. The...

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Published in:	Annals of surgery Vol. 260; no. 5; p. 829
Main Authors:	Schadde, Erik, Ardiles, Victoria, Robles-Campos, Ricardo, Malago, Massimo, Machado, Marcel, Hernandez-Alejandro, Roberto, Soubrane, Olivier, Schnitzbauer, Andreas A, Raptis, Dimitri, Tschuor, Christoph, Petrowsky, Henrik, De Santibanes, Eduardo, Clavien, Pierre-Alain
Format:	Journal Article
Language:	English
Published:	United States 01.11.2014
Subjects:	Aged Female Hepatectomy - methods Hepatectomy - mortality Humans Liver Neoplasms - mortality Liver Neoplasms - surgery Male Middle Aged Outcome and Process Assessment (Health Care) Postoperative Complications - epidemiology Registries Risk Factors Survival Rate
ISSN:	1528-1140, 1528-1140
Online Access:	Get more information
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Abstract	To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry. ALPPS induces accelerated growth of small future liver remnants (FLR) to allow curative resection of liver tumors. There is concern about safety based on reports of higher morbidity and mortality. A Web-based data entry system was created with password access and data pseudoencryption (NCT01924741). All patients with complete 90-day data were included. Multivariate logistic regression analysis was performed to identify independent risk factors for severe complications and mortality and volume growth of the FLR. Complete data were available for 202 patients. A total of 141 (70%) patients had colorectal liver metastases (CRLM). Median starting standardized future liver remnants of 21% increased by 80% within a median of 7 days. Ninety-day mortality was 19/202 (9%). Severe complications including mortalities (Clavien-Dindo≥IIIb) occurred in 27% of patients. Independent factors for severe complications were red blood cell transfusion [odds ratio (OR), 5.2), ALPPS stage I operating time greater than 300 minutes (OR, 4.4), age more than 60 years (OR, 3.8), and non-CRLM (OR, 2.7). Age, use of Pringle maneuver, and histologic changes led to less volume growth. In patients younger than 60 years with CRLM, 90-day mortality was similar to conventional 2-stage hepatectomies for CRLM. This is the first analysis of the ALPPS registry showing that ALPPS has increased perioperative morbidity and mortality in older patients but better outcomes in patients with CRLM.
AbstractList	To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry.OBJECTIVESTo assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry.ALPPS induces accelerated growth of small future liver remnants (FLR) to allow curative resection of liver tumors. There is concern about safety based on reports of higher morbidity and mortality.BACKGROUNDALPPS induces accelerated growth of small future liver remnants (FLR) to allow curative resection of liver tumors. There is concern about safety based on reports of higher morbidity and mortality.A Web-based data entry system was created with password access and data pseudoencryption (NCT01924741). All patients with complete 90-day data were included. Multivariate logistic regression analysis was performed to identify independent risk factors for severe complications and mortality and volume growth of the FLR.METHODSA Web-based data entry system was created with password access and data pseudoencryption (NCT01924741). All patients with complete 90-day data were included. Multivariate logistic regression analysis was performed to identify independent risk factors for severe complications and mortality and volume growth of the FLR.Complete data were available for 202 patients. A total of 141 (70%) patients had colorectal liver metastases (CRLM). Median starting standardized future liver remnants of 21% increased by 80% within a median of 7 days. Ninety-day mortality was 19/202 (9%). Severe complications including mortalities (Clavien-Dindo≥IIIb) occurred in 27% of patients. Independent factors for severe complications were red blood cell transfusion [odds ratio (OR), 5.2), ALPPS stage I operating time greater than 300 minutes (OR, 4.4), age more than 60 years (OR, 3.8), and non-CRLM (OR, 2.7). Age, use of Pringle maneuver, and histologic changes led to less volume growth. In patients younger than 60 years with CRLM, 90-day mortality was similar to conventional 2-stage hepatectomies for CRLM.RESULTSComplete data were available for 202 patients. A total of 141 (70%) patients had colorectal liver metastases (CRLM). Median starting standardized future liver remnants of 21% increased by 80% within a median of 7 days. Ninety-day mortality was 19/202 (9%). Severe complications including mortalities (Clavien-Dindo≥IIIb) occurred in 27% of patients. Independent factors for severe complications were red blood cell transfusion [odds ratio (OR), 5.2), ALPPS stage I operating time greater than 300 minutes (OR, 4.4), age more than 60 years (OR, 3.8), and non-CRLM (OR, 2.7). Age, use of Pringle maneuver, and histologic changes led to less volume growth. In patients younger than 60 years with CRLM, 90-day mortality was similar to conventional 2-stage hepatectomies for CRLM.This is the first analysis of the ALPPS registry showing that ALPPS has increased perioperative morbidity and mortality in older patients but better outcomes in patients with CRLM.CONCLUSIONSThis is the first analysis of the ALPPS registry showing that ALPPS has increased perioperative morbidity and mortality in older patients but better outcomes in patients with CRLM. To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry. ALPPS induces accelerated growth of small future liver remnants (FLR) to allow curative resection of liver tumors. There is concern about safety based on reports of higher morbidity and mortality. A Web-based data entry system was created with password access and data pseudoencryption (NCT01924741). All patients with complete 90-day data were included. Multivariate logistic regression analysis was performed to identify independent risk factors for severe complications and mortality and volume growth of the FLR. Complete data were available for 202 patients. A total of 141 (70%) patients had colorectal liver metastases (CRLM). Median starting standardized future liver remnants of 21% increased by 80% within a median of 7 days. Ninety-day mortality was 19/202 (9%). Severe complications including mortalities (Clavien-Dindo≥IIIb) occurred in 27% of patients. Independent factors for severe complications were red blood cell transfusion [odds ratio (OR), 5.2), ALPPS stage I operating time greater than 300 minutes (OR, 4.4), age more than 60 years (OR, 3.8), and non-CRLM (OR, 2.7). Age, use of Pringle maneuver, and histologic changes led to less volume growth. In patients younger than 60 years with CRLM, 90-day mortality was similar to conventional 2-stage hepatectomies for CRLM. This is the first analysis of the ALPPS registry showing that ALPPS has increased perioperative morbidity and mortality in older patients but better outcomes in patients with CRLM.
Author	Malago, Massimo Robles-Campos, Ricardo Raptis, Dimitri Clavien, Pierre-Alain Hernandez-Alejandro, Roberto Petrowsky, Henrik Soubrane, Olivier De Santibanes, Eduardo Ardiles, Victoria Schadde, Erik Machado, Marcel Tschuor, Christoph Schnitzbauer, Andreas A
Author_xml	– sequence: 1 givenname: Erik surname: Schadde fullname: Schadde, Erik organization: Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland †Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina ‡Department of General Surgery, Liver Transplant Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain §Department of HPB and Liver Transplant Surgery, Royal Free Hospital, University College London, London, United Kingdom ¶Department of Surgery, Sirio Libanes Hospital, University of Sao Paolo, Sao Paolo, Brazil ‖Department of Surgery, Division of HPB Surgery, Western University Medical Center, London, Ontario, Canada Department of HPB Surgery and Liver Transplantation, St. Antoine Hospital, Paris, France ††Department of Visceral- and Transplantation Surgery, Johann Wolfgang von Goethe University, Frankfurt, Germany. §§Hospital Paul Brousse, Université Paris Sud, Paris, France – sequence: 2 givenname: Victoria surname: Ardiles fullname: Ardiles, Victoria – sequence: 3 givenname: Ricardo surname: Robles-Campos fullname: Robles-Campos, Ricardo – sequence: 4 givenname: Massimo surname: Malago fullname: Malago, Massimo – sequence: 5 givenname: Marcel surname: Machado fullname: Machado, Marcel – sequence: 6 givenname: Roberto surname: Hernandez-Alejandro fullname: Hernandez-Alejandro, Roberto – sequence: 7 givenname: Olivier surname: Soubrane fullname: Soubrane, Olivier – sequence: 8 givenname: Andreas A surname: Schnitzbauer fullname: Schnitzbauer, Andreas A – sequence: 9 givenname: Dimitri surname: Raptis fullname: Raptis, Dimitri – sequence: 10 givenname: Christoph surname: Tschuor fullname: Tschuor, Christoph – sequence: 11 givenname: Henrik surname: Petrowsky fullname: Petrowsky, Henrik – sequence: 12 givenname: Eduardo surname: De Santibanes fullname: De Santibanes, Eduardo – sequence: 13 givenname: Pierre-Alain surname: Clavien fullname: Clavien, Pierre-Alain
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/25379854$$D View this record in MEDLINE/PubMed
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ContentType	Journal Article
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Snippet	To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an...
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SubjectTerms	Aged Female Hepatectomy - methods Hepatectomy - mortality Humans Liver Neoplasms - mortality Liver Neoplasms - surgery Male Middle Aged Outcome and Process Assessment (Health Care) Postoperative Complications - epidemiology Registries Risk Factors Survival Rate
Title	Early survival and safety of ALPPS: first report of the International ALPPS Registry
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