Journal article
First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases.
- Petrowsky H Swiss HPB and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
- Linecker M Swiss HPB and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
- Raptis DA Department of HPB- and Liver Transplantation Surgery, University College London, Royal Free Hospitals, London, UK.
- Kuemmerli C Swiss HPB and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
- Fritsch R Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.
- Kirimker OE Department of Surgery, Ankara University, Ankara, Turkey.
- Balci D Department of Surgery, Ankara University, Ankara, Turkey.
- Ratti F Hepatobiliary Surgery Division, Department of Surgery, IRCCS San Raffaele Hospital, School of Medicine, Milan, Italy.
- Aldrighetti L Hepatobiliary Surgery Division, Department of Surgery, IRCCS San Raffaele Hospital, School of Medicine, Milan, Italy.
- Voskanyan S Department of Surgery, A.I. Burnazyan FMBC Russian State Scientific Center of FMBA, Moscow, Russia.
- Tomassini F Department of Human Structure and Repair, Ghent University Faculty of Medicine, Ghent, Belgium.
- Troisi RI Department of Human Structure and Repair, Ghent University Faculty of Medicine, Ghent, Belgium.
- Bednarsch J Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH Aachen, Germany.
- Lurje G Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH Aachen, Germany.
- Fard-Aghaie MH Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
- Reese T Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
- Oldhafer KJ Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
- Ghamarnejad O Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
- Mehrabi A Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
- Abraham MET Department of Surgery, Division of HPB Surgery and Liver Transplantation, London Health Sciences Centre, London, Ontario, Canada.
- Truant S Department of Digestive Surgery and Transplantation, University Hospital, Lille, France.
- Pruvot FR Department of Digestive Surgery and Transplantation, University Hospital, Lille, France.
- Hoti E Department of Hepatobiliary and Liver Transplant Surgery, St. Vincents University Hospital, Dublin, Ireland.
- Kambakamba P Department of Hepatobiliary and Liver Transplant Surgery, St. Vincents University Hospital, Dublin, Ireland.
- Capobianco I Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Germany.
- Nadalin S Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Germany.
- Fernandes ESM Department of General Surgery and Transplantation, Hospital Adventista Silvestre, and Department of Surgery, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
- Kron P Swiss HPB and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
- Lodge P HPB and Transplant Unit, St. James's University Hospital, Leeds, UK.
- Olthof PB Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
- van Gulik T Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
- Castro-Benitez C Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
- Adam R Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
- Machado MA Department of Surgery, University of São Paulo, São Paulo, Brazil.
- Teutsch M Department of Hepatobiliary Surgery and Transplantation University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Li J Department of Hepatobiliary Surgery and Transplantation University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Scherer MN Department of Surgery and Transplantation, University Hospital Regensburg, Regensburg, Germany.
- Schlitt HJ Department of Surgery and Transplantation, University Hospital Regensburg, Regensburg, Germany.
- Ardiles V Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
- de Santibañes E Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
- Brusadin R Department of Surgery and Liver and Pancreas Transplantation, Virgen de la Arrixaca Clinic and University Hospital and IMIB, Murcia, Spain.
- Lopez-Lopez V Department of Surgery and Liver and Pancreas Transplantation, Virgen de la Arrixaca Clinic and University Hospital and IMIB, Murcia, Spain.
- Robles-Campos R Department of Surgery and Liver and Pancreas Transplantation, Virgen de la Arrixaca Clinic and University Hospital and IMIB, Murcia, Spain.
- Malagó M Department of HPB- and Liver Transplantation Surgery, University College London, Royal Free Hospitals, London, UK.
- Hernandez-Alejandro R Department of Surgery, Division of HPB Surgery and Liver Transplantation, London Health Sciences Centre, London, Ontario, Canada.
- Clavien PA Swiss HPB and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
- 2020-08-25
Published in:
- Annals of surgery. - 2020
Aged
Colorectal Neoplasms
Female
Hepatectomy
Humans
Liver Neoplasms
Male
Middle Aged
Postoperative Complications
Registries
Risk Factors
Survival Analysis
English
OBJECTIVES
To analyze long-term oncological outcome along with prognostic risk factors in a large cohort of patients with colorectal liver metastases (CRLM) undergoing ALPPS.
BACKGROUND
ALPPS is a two-stage hepatectomy variant that increases resection rates and R0 resection rates in patients with primarily unresectable CRLM as evidenced in a recent randomized controlled trial. Long-term oncologic results, however, are lacking.
METHODS
Cases in- and outside the International ALPPS Registry were collected and completed by direct contacts to ALPPS centers to secure a comprehensive cohort. Overall, cancer-specific (CSS), and recurrence-free (RFS) survivals were analyzed along with independent risk factors using Cox-regression analysis.
RESULTS
The cohort included 510 patients from 22 ALPPS centers over a 10-year period. Ninety-day mortality was 4.9% and median overall survival, CSS, and RFS were 39, 42, and 15 months, respectively. The median follow-up time was 38 months (95% confidence interval 32-43 months). Multivariate analysis identified tumor-characteristics (primary T4, right colon), biological features (K/N-RAS status), and response to chemotherapy (Response Evaluation Criteria in Solid Tumors) as independent predictors of CSS. Traditional factors such as size of metastases, uni versus bilobar involvement, and liver-first approach were not predictive. When hepatic recurrences after ALPPS was amenable to surgical/ablative treatment, median CSS was significantly superior compared to chemotherapy alone (56 vs 30 months, P < 0.001).
CONCLUSIONS
This large cohort provides the first evidence that patients with primarily unresectable CRLM treated by ALPPS have not only low perioperative mortality, but achieve appealing long-term oncologic outcome especially those with favorable tumor biology and good response to chemotherapy.
To analyze long-term oncological outcome along with prognostic risk factors in a large cohort of patients with colorectal liver metastases (CRLM) undergoing ALPPS.
BACKGROUND
ALPPS is a two-stage hepatectomy variant that increases resection rates and R0 resection rates in patients with primarily unresectable CRLM as evidenced in a recent randomized controlled trial. Long-term oncologic results, however, are lacking.
METHODS
Cases in- and outside the International ALPPS Registry were collected and completed by direct contacts to ALPPS centers to secure a comprehensive cohort. Overall, cancer-specific (CSS), and recurrence-free (RFS) survivals were analyzed along with independent risk factors using Cox-regression analysis.
RESULTS
The cohort included 510 patients from 22 ALPPS centers over a 10-year period. Ninety-day mortality was 4.9% and median overall survival, CSS, and RFS were 39, 42, and 15 months, respectively. The median follow-up time was 38 months (95% confidence interval 32-43 months). Multivariate analysis identified tumor-characteristics (primary T4, right colon), biological features (K/N-RAS status), and response to chemotherapy (Response Evaluation Criteria in Solid Tumors) as independent predictors of CSS. Traditional factors such as size of metastases, uni versus bilobar involvement, and liver-first approach were not predictive. When hepatic recurrences after ALPPS was amenable to surgical/ablative treatment, median CSS was significantly superior compared to chemotherapy alone (56 vs 30 months, P < 0.001).
CONCLUSIONS
This large cohort provides the first evidence that patients with primarily unresectable CRLM treated by ALPPS have not only low perioperative mortality, but achieve appealing long-term oncologic outcome especially those with favorable tumor biology and good response to chemotherapy.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1097/SLA.0000000000004330
- PMID 32833765
- Persistent URL
- https://sonar.ch/global/documents/145363
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