Journal article
Survival after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for advanced colorectal liver metastases: A case-matched comparison with palliative systemic therapy.
- Olthof PB Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: p.b.olthof@amc.nl.
- Huiskens J Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
- Wicherts DA Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
- Huespe PE Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Ardiles V Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- Robles-Campos R Servicio de Cirugía General y Aparato Digestivo, Virgen de la Arrixaca University Hospital, Murcia, Spain.
- Adam R Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
- Linecker M Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland.
- Clavien PA Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland.
- Koopman M Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
- Verhoef C Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
- Punt CJ Department of Medical Oncology, Academic Medical Center, Amsterdam, the Netherlands.
- van Gulik TM Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
- de Santibanes E Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
- 2017-01-01
Published in:
- Surgery. - 2017
Aged
Case-Control Studies
Colorectal Neoplasms
Disease-Free Survival
Female
Hepatectomy
Humans
Ligation
Liver Neoplasms
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Palliative Care
Patient Selection
Portal Vein
Prognosis
Registries
Risk Assessment
Survival Analysis
Treatment Outcome
English
BACKGROUND
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment.
METHODS
All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival.
RESULTS
Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and <2 criteria, respectively (P = .002). Median disease-free survival was 6 months compared to 12 months (P < .001) in the ≥2 and <2 criteria groups, respectively. Median overall survival was comparable between ALPPS patients with ≥2 criteria and case-matched patients who received palliative treatment (24.0 vs 17.6 months, P = .088).
CONCLUSION
Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment.
METHODS
All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival.
RESULTS
Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and <2 criteria, respectively (P = .002). Median disease-free survival was 6 months compared to 12 months (P < .001) in the ≥2 and <2 criteria groups, respectively. Median overall survival was comparable between ALPPS patients with ≥2 criteria and case-matched patients who received palliative treatment (24.0 vs 17.6 months, P = .088).
CONCLUSION
Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.surg.2016.10.032
- PMID 28038862
- Persistent URL
- https://sonar.ch/global/documents/260546
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