TY - JOUR
T1 - First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases
AU - Petrowsky, Henrik
AU - Linecker, Michael
AU - Raptis, Dimitri A.
AU - Kuemmerli, Christoph
AU - Fritsch, Ralph
AU - Kirimker, Onur E.
AU - Balci, Deniz
AU - Ratti, Francesca
AU - Aldrighetti, Luca
AU - Voskanyan, Sergey
AU - Tomassini, Federico
AU - Troisi, Roberto I.
AU - Bednarsch, Jan
AU - Lurje, Georg
AU - Fard-Aghaie, Mohammad-Hossein
AU - Reese, Tim
AU - Oldhafer, Karl J.
AU - Ghamarnejad, Omid
AU - Mehrabi, Arianeb
AU - Abraham, Mauro E. Tun
AU - Truant, Stéphanie
AU - Pruvot, Francois-René
AU - Hoti, Emir
AU - Kambakamba, Patryk
AU - Capobianco, Ivan
AU - Nadalin, Silvio
AU - Fernandes, Eduardo S. M.
AU - Kron, Philipp
AU - Lodge, Peter
AU - Olthof, Pim B.
AU - van Gulik, Thomas
AU - Castro-Benitez, Carlos
AU - Adam, René
AU - Machado, Marcel Autran
AU - Teutsch, Martin
AU - Li, Jun
AU - Scherer, Marcus N.
AU - Schlitt, Hans J.
AU - Ardiles, Victoria
AU - de Santibañes, Eduardo
AU - Brusadin, Roberto
AU - Lopez-Lopez, Victor
AU - Robles-Campos, Ricardo
AU - Malagó, Massimo
AU - Hernandez-Alejandro, Roberto
AU - Clavien, Pierre-Alain
N1 - Copyright: This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine
PY - 2020/11/1
Y1 - 2020/11/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85092945623&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/SLA.0000000000004330
DO - https://doi.org/10.1097/SLA.0000000000004330
M3 - Article
C2 - 32833765
SN - 0003-4932
VL - 272
SP - 793
EP - 800
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -