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Early Survival and Safety of ALPPS: First Report of the International ALPPS Registry

published by Administrator on 29 November, 2014 - 12:38
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General discussion

 

Schadde, Erik MD, FACS*; Ardiles, Victoria MD†; Robles-Campos, Ricardo MD‡; Malago, Massimo MD, FACS§; Machado, Marcel MD; Hernandez-Alejandro, Roberto MD||; Soubrane, Olivier MD**; Schnitzbauer, Andreas A. MD††; Raptis, Dimitri MD*; Tschuor, Christoph MD*; Petrowsky, Henrik MD, FACS*; De Santibanes, Eduardo MD, PhD, FACS†; Clavien, Pierre-Alain MD, PhD, FACS*,§§; On behalf of the ALPPS Registry Group

*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

Ann Surg. 2014 Nov;260(5):829-38.

INTERNATIONAL ALPPS REGISTRY GROUP AUTHORS 
Eddie Abdalla, American University in Beirut, Beirut, Libanon (Member Scientific Committee); Rene Adam, Hopital Paul Brousse, Villejuif, France; Dmitri Alden, Vassar Brothers Medical Center, Poughkeepsie, NY; Luca Antonio Aldrighetti, San Raffaele Hospital, Milano, Italy; Emilio Alvarez-Prida de Paz, Complejo Asistencial Universitario de Leon, Leon, Spain; Silvio Balzan, UNISC - Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil; Jeffrey Barkun, McGill University, Montreal, Canada (Member Scientific Committee); Bergthor Björnsson, Linköping University Hospital, Linköping, Sweden; Carlos Castro-Benitez, Hôpital Paul Brousse, Villejuif, France; Raffaele Brustia, Hopital St. Antoine, Paris, France; William C. Chapman, Washington University in St. Louis, St. Louis, MO; Nikita Chardarov, Russian Research Center of Surgery, Moscow, Russia; Denis Chaychenko, Regional Oncology Hospital, Chelyabinsk, Chelyabinsk, Russia; Daniel Cherqui, Hepatobiliary Center, Villejuif, France; Laura Corradetti, Ospedale Maggiore, Bologna, Bologna, Italy; Kris Croome, Western University, London, Ontario, Canada; Esteban Cugat, Hospital Universitari Mutua Terrassa, Terrassa, Spain; Jiahong Dong, PLA General Hospital, Beijing, China; Vincent Donckier, Erasme University Hospital, Brussels, Belgium; Alexandre Doussot, University Hospital of Dijon, Dijon, France; Marcelo Enne, Hospital Federal de Ipanema, Rio de Janeiro, Brazil; Joan Figueras, Josep Trueta Hospital, Girona, Spain; Erik Herrero Fonollosa, Hospital Universitari Mutua Terrassa, Spain; Riccardo Gauzolino, University Hospital Poitiers, Poitiers, France; Giuseppe Kito Fusai, Royal Free Hospital, London, London, United Kingdom; Thomas Gruenberger, Medical University Vienna, Vienna, Austria; Xavier Maximilien Keutgen, University Hospital of Zurich, Zurich, Switzerland; Alan Koffron, Beaumont Health System, Royal Oak, MI; Norihiro Kukudo, Graduate School of Medicine—University of Tokyo, Tokyo, Japan (Member Scientific Committee); Javier Lendoire, Hospital Dr. Cosme Argerich, Buenos Aires, Argentina; Jun Li, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; J. Peter A Lodge, St. James's University Hospital, Leeds, United Kingdom (Member Scientific Committee); Susan Logan, UCSF—Fresno, Fresno CA; Dario Lorenzin, University Hospital “S.M. della Misericordia”, Udine, Italy; Valerio Lucidi, Erasme University Hospital (ULB), Brussels, Belgium; Georg Lurje, University Hospital of Zurich, Zurich, Switzerland; Michele Masetti, Maggiore Hospital AUSL Bologna, Bologna, Italy; Lucas McCormack, Hospital Aleman of Buenos Aires, Buenos Aires, Argentina; Roberto Montalti, Azienda Ospedaliero Universitaria—Ospedali Riuniti di Ancona, Ancona, Italy; Masato Nagino, Nagoya University Graduate School of Medicine, Nagoya, Japan (Member Scientific Committee); Natascha Nüssler, Klinikum Neuperlach, Städtisches Klinikum München GmbH, München, Germany; Pablo Ortega-Deballon, University Hospital of Dijon, Dijon, France; Karen Pineda, Western University, London, Ontario, Canada; Theodora Pissanou, Royal Free Hospital, London, London, United Kingdom; Francesca Ratti, San Raffaele Hospital, Milano, Italy; Jean-Marc Regimbeau, CHU Nord, Amiens, France; Xavier Rogiers, Gent University Hospital and Medical School, Gent, Belgium (Member Scientific Committee); Yoshihiro Sakamoto, Graduate School of Medicine—University of Tokyo, Tokyo, Japan; Per Sandström, Linköping University Hospital, Linköping, Sweden; Julio Santoyo, Hospital Universitario Carlos Haya, Malaga, Malaga, Spain; Olivier Scatton, St. Antoine Hospital, Paris, France; Gregory Sergeant, University Hospital of Zurich, Zurich, Switzerland; Alejandro Serrablo, Miguel Servet University Hospital, Zaragoza, Zaragoza, Spain; Dinesh Sharma, Royal Free London Foundation NHS Trust, London, United Kingdom; Oleg Skipenko, Russian Research Center of Surgery, Moscow, Russia; Evgeny Solomonov, Beilinson Hospital, RMC, Petah Tiqva, Israel; Ernesto Sparrelid, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Stojanovic Stojanovic, University Clinical Center Niš, Nis, Serbia; Steven Strassberg, Washington University in St. Louis, St. Louis, MO (Member Scientific Committee); Hans Torrenga, VUMC, Amsterdam, The Netherlands; Roberto Troisi, Gent University Hospital and Medical School, Gent, Belgium; Stéphanie Truant, CHRU Lille, Lille, France; Neeta Vachharajani, Washington University in St. Louis, St. Louis, MO; Eduardo Viana de Carvalho, Hospital de Ipanema, Rio de Janeiro, Brazil; Eric Vibert, Hopital Paul Brousse, Villejuif, France; Emilio Vicente, Madrid Sanchinarro University Hospital, Madrid, Spain; Marco Vivarelli, Azienda Ospedaliero Universitaria-Ospedali Riuniti di Ancona, Ancona, Italy; Soumil Vyas, Royal Free Hospital, London, London, United Kingdom; Zhang Wen, The first affiliated hospital, Guangxi Medical University, Nanning, China; Wang Zheng, Liver Surgery Department, Shanghai, China; and Jian Zhou, Liver Surgery Department, Shanghai, China.

 

ABSTRACT

OBJECTIVES: 

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.

BACKGROUND: 

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.

METHODS: 

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.

RESULTS: 

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.

CONCLUSIONS: 

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.

PMID: 25379854

 

Headquarters

University Hospital Zurich
Department of Surgery
Raemistrasse 100
8091 Zurich, Switzerland

Contacts

Phone: +41 (0)44 255 33 00
Fax:     +41 (0)44 255 44 49
Email:  ALPPS@usz.ch