ALPPS Offers a Better Chance of Complete Resection in Patients with Primarily Unresectable Liver Tumors Compared with Conventional-Staged Hepatectomies: Results ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2014-04-19

AUTHORS

Erik Schadde, Victoria Ardiles, Ksenija Slankamenac, Christoph Tschuor, Gregory Sergeant, Nadja Amacker, Janine Baumgart, Kris Croome, Roberto Hernandez-Alejandro, Hauke Lang, Eduardo de Santibaňes, Pierre-Alain Clavien

ABSTRACT

BackgroundPortal vein occlusion to increase the size of the future liver remnant (FLR) is well established, using portal vein ligation (PVL) or embolization (PVE) followed by resection 4–8 weeks later. Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) combines PVL and complete parenchymal transection, followed by hepatectomy within 1–2 weeks. ALPPS has been recently introduced but remains controversial. We compare the ability of ALPPS versus PVE or PVL for complete tumor resection.MethodsA retrospective review of all patients undergoing ALPPS or conventional staged hepatectomies using PVL or PVE at four high-volume HPB centres between 2003 and 2012 was performed. Patients with primary liver tumors and liver metastases were included. Primary endpoint was complete tumor resection. Secondary endpoints include 90-day mortality, complications, FLR increase, time to resection, and tumor recurrence.ResultsForty-eight patients with ALPPS were compared with 83 patients with conventional-staged hepatectomies. Eighty-three percent (40/48 patients) of ALPPS patients achieved complete resection compared with 66 % (55/83 patients) in PVE/PVL (odds ratio 3.34, p = 0.027). Ninety-day mortality in ALPPS and PVE/PVL was 15 and 6 %, respectively (p = 0.2). Extrapolated growth rate was 11 times higher in ALPPS (34.8 cc/day; interquartile range (IQR) 26–49) compared with PVE/PVL (3 cc/day; IQR2-6; p = 0.001). Tumor recurrence at 1 year was 54 versus 52 % for ALPPS and PVE/PVL, respectively (p = 0.7).ConclusionsThis study provides evidence that ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors at the cost of a high mortality. The technique is promising but should currently not be used outside of studies and registries. More... »

PAGES

1510-1519

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00268-014-2513-3

DOI

http://dx.doi.org/10.1007/s00268-014-2513-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1046702298

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24748319


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35 schema:description BackgroundPortal vein occlusion to increase the size of the future liver remnant (FLR) is well established, using portal vein ligation (PVL) or embolization (PVE) followed by resection 4–8 weeks later. Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) combines PVL and complete parenchymal transection, followed by hepatectomy within 1–2 weeks. ALPPS has been recently introduced but remains controversial. We compare the ability of ALPPS versus PVE or PVL for complete tumor resection.MethodsA retrospective review of all patients undergoing ALPPS or conventional staged hepatectomies using PVL or PVE at four high-volume HPB centres between 2003 and 2012 was performed. Patients with primary liver tumors and liver metastases were included. Primary endpoint was complete tumor resection. Secondary endpoints include 90-day mortality, complications, FLR increase, time to resection, and tumor recurrence.ResultsForty-eight patients with ALPPS were compared with 83 patients with conventional-staged hepatectomies. Eighty-three percent (40/48 patients) of ALPPS patients achieved complete resection compared with 66 % (55/83 patients) in PVE/PVL (odds ratio 3.34, p = 0.027). Ninety-day mortality in ALPPS and PVE/PVL was 15 and 6 %, respectively (p = 0.2). Extrapolated growth rate was 11 times higher in ALPPS (34.8 cc/day; interquartile range (IQR) 26–49) compared with PVE/PVL (3 cc/day; IQR2-6; p = 0.001). Tumor recurrence at 1 year was 54 versus 52 % for ALPPS and PVE/PVL, respectively (p = 0.7).ConclusionsThis study provides evidence that ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors at the cost of a high mortality. The technique is promising but should currently not be used outside of studies and registries.
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43 ALPPS patients
44 BackgroundPortal vein occlusion
45 ConclusionsThis study
46 Conventional-Staged Hepatectomies
47 Extrapolated growth rate
48 FLR increase
49 HPB centers
50 MethodsA retrospective review
51 Ninety-day mortality
52 PVE
53 PVE/PVL
54 ResultsForty-eight patients
55 Secondary endpoints
56 ability
57 ability of ALPPS
58 analysis
59 best chance
60 center
61 chance
62 complete resection
63 complete tumor resection
64 complications
65 conventional-staged hepatectomies
66 cost
67 embolization
68 endpoint
69 evidence
70 future liver remnant
71 growth rate
72 hepatectomy
73 high mortality
74 high-volume HPB centres
75 increase
76 ligation
77 liver metastases
78 liver partition
79 liver remnant
80 liver tumors
81 metastasis
82 mortality
83 multicenter analysis
84 occlusion
85 parenchymal transection
86 partition
87 patients
88 percent
89 portal vein ligation
90 primary endpoint
91 primary liver tumors
92 rate
93 recurrence
94 registry
95 remnants
96 resection
97 resection 4
98 results
99 retrospective review
100 review
101 size
102 study
103 technique
104 time
105 transection
106 tumor recurrence
107 tumor resection
108 tumors
109 unresectable liver tumors
110 vein ligation
111 vein occlusion
112 weeks
113 years
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