Journal article
Defining Benchmark Outcomes for ALPPS.
- Raptis DA Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Switzerland.
- Linecker M Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Switzerland.
- Kambakamba P Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Switzerland.
- Tschuor C Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Switzerland.
- Müller PC Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Switzerland.
- Hadjittofi C Department of HPB Surgery and Liver Transplantation, Royal Free London Hospital, NHS Foundation Trust, London, United Kingdom.
- Stavrou GA Department of General, Abdominal, and Oncology Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
- Fard-Aghaie MH Department of General, Abdominal, and Oncology Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
- Tun-Abraham M Department of Surgery London Health Sciences Centre, Ontario, Canada.
- Ardiles V Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Malagó M Department of HPB Surgery and Liver Transplantation, Royal Free London Hospital, NHS Foundation Trust, London, United Kingdom.
- Campos RR Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.
- Oldhafer KJ Department of General, Abdominal, and Oncology Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
- Hernandez-Alejandro R Department of Surgery London Health Sciences Centre, Ontario, Canada.
- de Santibañes E Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Machado MA Department of Surgery, Sirio Libanes Hospital, Sao Paulo, Brazil.
- Petrowsky H Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Switzerland.
- Clavien PA Swiss HPB and Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Switzerland.
- 2019-10-09
Published in:
- Annals of surgery. - 2019
Adult
Aged
Benchmarking
Colorectal Neoplasms
Disease-Free Survival
Female
Hepatectomy
Humans
Internationality
Ligation
Liver Neoplasms
Male
Middle Aged
Portal Vein
Postoperative Complications
Prognosis
Registries
Risk Assessment
Survival Analysis
Treatment Outcome
English
OBJECTIVE
The aim of this study was to use the concept of benchmarking to establish robust and standardized outcome references after the procedure ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy).
BACKGROUND AND AIMS
The recently developed ALPPS procedure, aiming at removing primarily unresectable liver tumors, has been criticized for safety issues with high variations in the reported morbidity/mortality rates depending on patient, disease, technical characteristics, and center experience. No reference values for relevant outcome parameters are available.
METHODS
Among 1036 patients registered in the international ALPPS registry, 120 (12%) were benchmark cases fulfilling 4 criteria: patients ≤67 years of age, with colorectal metastases, without simultaneous abdominal procedures, and centers having performed ≥30 cases. Benchmark values, defined as the 75th percentile of the median outcome parameters of the centers, were established for 10 clinically relevant domains.
RESULTS
The benchmark values were completion of stage 2: ≥96%, postoperative liver failure (ISGLS-criteria) after stage 2: ≤5%, ICU stay after ALPPS stages 1 and 2: ≤1 and ≤2 days, respectively, interstage interval: ≤16 days, hospital stay after ALPPS stage 2: ≤10 days, rates of overall morbidity in combining both stage 1 and 2: ≤65% and for major complications (grade ≥3a): ≤38%, 90-day comprehensive complication index was ≤22, the 30-, 90-day, and 6-month mortality was ≤4%, ≤5%, and 6%, respectively, the overall 1-year, recurrence-free, liver-tumor-free, and extrahepatic disease-free survival was ≥86%, ≥50%, ≥57%, and ≥65%, respectively.
CONCLUSIONS
This benchmark analysis sets key reference values for ALPPS, indicating similar outcome as other types of major hepatectomies. Benchmark cutoffs offer valid tools not only for comparisons with other procedures, but also to assess higher risk groups of patients or different indications than colorectal metastases.
The aim of this study was to use the concept of benchmarking to establish robust and standardized outcome references after the procedure ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy).
BACKGROUND AND AIMS
The recently developed ALPPS procedure, aiming at removing primarily unresectable liver tumors, has been criticized for safety issues with high variations in the reported morbidity/mortality rates depending on patient, disease, technical characteristics, and center experience. No reference values for relevant outcome parameters are available.
METHODS
Among 1036 patients registered in the international ALPPS registry, 120 (12%) were benchmark cases fulfilling 4 criteria: patients ≤67 years of age, with colorectal metastases, without simultaneous abdominal procedures, and centers having performed ≥30 cases. Benchmark values, defined as the 75th percentile of the median outcome parameters of the centers, were established for 10 clinically relevant domains.
RESULTS
The benchmark values were completion of stage 2: ≥96%, postoperative liver failure (ISGLS-criteria) after stage 2: ≤5%, ICU stay after ALPPS stages 1 and 2: ≤1 and ≤2 days, respectively, interstage interval: ≤16 days, hospital stay after ALPPS stage 2: ≤10 days, rates of overall morbidity in combining both stage 1 and 2: ≤65% and for major complications (grade ≥3a): ≤38%, 90-day comprehensive complication index was ≤22, the 30-, 90-day, and 6-month mortality was ≤4%, ≤5%, and 6%, respectively, the overall 1-year, recurrence-free, liver-tumor-free, and extrahepatic disease-free survival was ≥86%, ≥50%, ≥57%, and ≥65%, respectively.
CONCLUSIONS
This benchmark analysis sets key reference values for ALPPS, indicating similar outcome as other types of major hepatectomies. Benchmark cutoffs offer valid tools not only for comparisons with other procedures, but also to assess higher risk groups of patients or different indications than colorectal metastases.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1097/SLA.0000000000003539
- PMID 31592812
- Persistent URL
- https://sonar.ch/global/documents/128440
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