First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases. Issue 5 (November 2020)

• Record Type: Journal Article
• Authors: Petrowsky, Henrik; Linecker, Michael; Raptis, Dimitri A.; Kuemmerli, Christoph; Fritsch, Ralph; Kirimker, Onur E.; Balci, Deniz; Ratti, Francesca; Aldrighetti, Luca; Voskanyan, Sergey; Tomassini, Federico; Troisi, Roberto I.; Bednarsch, Jan; Lurje, Georg; Fard-Aghaie, Mohammad-Hossein; Reese, Tim; Oldhafer, Karl J.; Ghamarnejad, Omid; Mehrabi, Arianeb; Abraham, Mauro E. Tun; Truant, Stéphanie; Pruvot, Francois-René; Hoti, Emir; Kambakamba, Patryk; Capobianco, Ivan; Nadalin, Silvio; Fernandes, Eduardo S. M.; Kron, Philipp; Lodge, Peter; Olthof, Pim B.; van Gulik, Thomas; Castro-Benitez, Carlos; Adam, René; Machado, Marcel Autran; Teutsch, Martin; Li, Jun; Scherer, Marcus N.; Schlitt, Hans J.; Ardiles, Victoria; de Santibañes, Eduardo; Brusadin, Roberto; Lopez-Lopez, Victor; Robles-Campos, Ricardo; Malagó, Massimo; Hernandez-Alejandro, Roberto; Clavien, Pierre-Alain;
• Is Part Of: Annals of surgery. Volume 272:Issue 5(2020)
• Publication Date: 2020-11
• Subjects: associating liver partition and portal vein ligation for staged hepatectomy -- cancer-specific survival -- colorectal liver metastases -- long-term outcome -- tumor biology; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000004330
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : 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. Abstract : Supplemental Digital Content is available in the text