First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases
Year: 2020
Type: article
Study design: Observational Study
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.
Source: Annals of Surgery
Authors: Henrik Petrowsky, Michael Linecker, Dimitri A. Raptis, Christoph Kuemmerli, Ralph Fritsch, Onur E. Kirimker, Deniz Balci, Francesca Ratti, Luca Aldrighetti, Sergey Voskanyan, Federico Tomassini, Roberto I. Troisi, Jan Bednarsch, Georg Lurje, Mohammad-Hossein Fard-Aghaie, Tim Reese, Karl J. Oldhafer, Omid Ghamarnejad, Arianeb Mehrabi, Mauro E. Tun Abraham, Stéphanie Truant, Francois-René Pruvot, Emir Hoti, Patryk Kambakamba, Ivan Capobianco, Silvio Nadalin, Eduardo S. M. Fernandes, Philipp Kron, Peter Lodge, Pim B. Olthof, Thomas van Gulik, Carlos Castro-Benitez, René Adam, Marcel Autran Machado, Martin Teutsch, Jun Li, Marcus N. Scherer, Hans J. Schlitt, Victoria Ardiles, Eduardo de Santibañes, Roberto Brusadin, Victor Lopez-Lopez, Ricardo Robles-Campos, Massimo Malagó, Roberto Hernandez-Alejandro, Pierre-Alain Clavien
Institutions: University Hospital Zurich, The Royal Free Hospital, University College London, Ankara University, IRCCS Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele, State Scientific Center of the Russian Federation - Federal Medical Biophysical Center named after A.I. Burnazyan, Ghent University, Federico II University Hospital, University of Naples Federico II, Universitätsklinikum Aachen, RWTH Aachen University, Charité - Universitätsmedizin Berlin, Semmelweis University, Asklepios Klinik Barmbek, Heidelberg University, London Health Sciences Centre, Centre Hospitalier Universitaire de Lille, St. Vincent's University Hospital, Universitätsklinikum Tübingen, University of Tübingen, Universidade Federal do Rio de Janeiro, Hospital Adventista Silvestre, St James's University Hospital, Amsterdam University Medical Centers, University of Amsterdam, Hôpital Paul-Brousse, Universidade de São Paulo, University Medical Center Hamburg-Eppendorf, University Hospital Regensburg, Hospital Italiano de Buenos Aires, Instituto Murciano de Investigación Biosanitaria, Hospital Universitario Virgen de la Arrixaca, University of Rochester Medicine, University of Rochester
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3080660494