The ALPPS Risk Score: Avoiding Futile Use of ALPPS.
- Linecker M *Department of Surgery and Transplantation, Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland†Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany‡Semmelweis University, Budapest, Campus Hamburg, Germany§Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland¶Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH Aachen, Germany||General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany**Department of Surgery and Liver and Pancreas transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain††Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina‡‡Department of HPB and Liver Transplant Surgery, University College London, Royal Free Hospital, London, UK.
- Stavrou GA
- Oldhafer KJ
- Jenner RM
- Seifert B
- Lurje G
- Bednarsch J
- Neumann U
- Capobianco I
- Nadalin S
- Robles-Campos R
- de Santibañes E
- Malagó M
- Lesurtel M
- Clavien PA
- Petrowsky H
- 2016-07-26
Published in:
- Annals of surgery. - 2016
Aged
Female
Hepatectomy
Hospital Mortality
Humans
Ligation
Liver Neoplasms
Logistic Models
Male
Medical Futility
Middle Aged
Operative Time
Portal Vein
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
English
OBJECTIVES
To create a prediction model identifying futile outcome in ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) before stage 1 and stage 2 surgery.
BACKGROUND
ALPPS is a 2-stage hepatectomy, which incorporates parenchymal transection at stage 1 enabling resection of extensive liver tumors. One of the major criticisms of ALPPS is the associated high mortality rate up to 20%.
METHODS
Using the International ALPPS Registry, a risk analysis for futile outcome (defined as 90-day or in-hospital mortality) was performed. Futility was modeled using multivariate regression analysis and a futility risk score formula was computed on the basis of the relative size of logistic model regression coefficients.
RESULTS
Among 528 ALPPS patients from 38 centers, a futile outcome was observed in 47 patients (9%). The pre-stage 1 model included age 67 years or older [odds ratio (OR) = 5.7], and tumor entity (OR = 3.8 for biliary tumors) as independent predictors of futility from multivariate analysis. For the pre-stage 1 model scores of 0, 1, 2, 3, 4 and 5 were associated with futile risk of 2.7%, 4.9%, 8.6%, 15%, 24%, and 37%. The pre-stage 2 model included major complications (grade ≥ 3b) after stage 1 (OR = 3.4), serum bilirubin (OR = 4.4), serum creatinine (OR = 5.4), and cumulative pre-stage 1 risk score (OR = 1.9). The model predicted futility risk of 5%, 10%, 20%, and 50% for patients with scores of 3.9, 4.7, 5.5, and 6.9, respectively.
CONCLUSIONS
Both models have an excellent prediction to assess the individual risk of futile outcome after ALPPS surgery and can be used to avoid futile use of ALPPS.
To create a prediction model identifying futile outcome in ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) before stage 1 and stage 2 surgery.
BACKGROUND
ALPPS is a 2-stage hepatectomy, which incorporates parenchymal transection at stage 1 enabling resection of extensive liver tumors. One of the major criticisms of ALPPS is the associated high mortality rate up to 20%.
METHODS
Using the International ALPPS Registry, a risk analysis for futile outcome (defined as 90-day or in-hospital mortality) was performed. Futility was modeled using multivariate regression analysis and a futility risk score formula was computed on the basis of the relative size of logistic model regression coefficients.
RESULTS
Among 528 ALPPS patients from 38 centers, a futile outcome was observed in 47 patients (9%). The pre-stage 1 model included age 67 years or older [odds ratio (OR) = 5.7], and tumor entity (OR = 3.8 for biliary tumors) as independent predictors of futility from multivariate analysis. For the pre-stage 1 model scores of 0, 1, 2, 3, 4 and 5 were associated with futile risk of 2.7%, 4.9%, 8.6%, 15%, 24%, and 37%. The pre-stage 2 model included major complications (grade ≥ 3b) after stage 1 (OR = 3.4), serum bilirubin (OR = 4.4), serum creatinine (OR = 5.4), and cumulative pre-stage 1 risk score (OR = 1.9). The model predicted futility risk of 5%, 10%, 20%, and 50% for patients with scores of 3.9, 4.7, 5.5, and 6.9, respectively.
CONCLUSIONS
Both models have an excellent prediction to assess the individual risk of futile outcome after ALPPS surgery and can be used to avoid futile use of ALPPS.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1097/SLA.0000000000001914
- PMID 27455156
- Persistent URL
- https://sonar.ch/global/documents/255615
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