ALPPS Improves Resectability Compared With Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastasis Results From a Scandinavian Multicenter Randomized Controlled Trial (LIGRO Trial)
Per Sandström,Bård I. Røsok,Ernesto Sparrelid,Peter Nørgaard Larsen,Anna Lindhoff Larsson,Gert Lindell,Nicolai A. Schultz,Bjørn Atle Bjørnbeth,Bengt Isaksson,Magnus Rizell,Bergthor Björnsson +10 more
TLDR
ALPPS is superior to TSH in terms of RR, with comparable surgical margins, complications, and short-term mortality.Abstract:
Objective: The aim of the study was to evaluate if associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) could increase resection rates (RRs) compared with two-stage hepatectomy (TSH) in a randomized controlled trial (RCT). Background: Radical liver metastasis resection offers the only chance of a cure for patients with metastatic colorectal cancer. Patients with colorectal liver metastasis (CRLM) and an insufficient future liver remnant (FLR) volume are traditionally treated with chemotherapy with portal vein embolization or ligation followed by hepatectomy (TSH). This treatment sometimes fails due to insufficient liver growth or tumor progression. Methods: A prospective, multicenter RCT was conducted between June 2014 and August 2016. It included 97 patients with CRLM and a standardized FLR (sFLR) of less than 30%. Primary outcome - RRs were measured as the percentages of patients completing both stages of the treatment. Secondary outcomes were complications, radicality, and 90-day mortality measured from the final intervention. Results: Baseline characteristics, besides body mass index, did not differ between the groups. The RR was 92% [95% confidence interval (CI) 84%-100%] (44/48) in the ALPPS arm compared with 57% (95% CI 43%-72%) (28/49) in the TSH arm [rate ratio 8.25 (95% CI 2.6-26.6); P < 0.0001]. No differences in complications (Clavien-Dindo ≥3a) [43% (19/44) vs 43% (12/28)] [1.01 (95% CI 0.4-2.6); P = 0.99], 90-day mortality [8.3% (4/48) vs 6.1% (3/49)] [1.39 [95% CI 0.3-6.6]; P = 0.68] or R0 RRs [77% (34/44) vs 57% (16/28)] [2.55 [95% CI 0.9-7.1]; P = 0.11)] were observed. Of the patients in the TSH arm that failed to reach an sFLR of 30%, 12 were successfully treated with ALPPS. Conclusion: ALPPS is superior to TSH in terms of RR, with comparable surgical margins, complications, and short-term mortality. (Less)read more
Citations
More filters
Journal ArticleDOI
Colorectal liver metastases: An update on multidisciplinary approach.
TL;DR: Evidence-based protocols are missing, and therefore optimal management of hepatic metastasis should be personalized and determined by a multi-disciplinary team.
Journal ArticleDOI
Modern therapeutic approaches for the treatment of malignant liver tumours
Henrik Petrowsky,Ralph Fritsch,Matthias Guckenberger,Michelle L. de Oliveira,Philipp Dutkowski,Pierre-Alain Clavien +5 more
TL;DR: The available therapies for the treatment of malignant liver tumours are summarized, with an emphasis on surgical and ablative approaches and how they align with other therapies such as modern anticancer drugs or radiotherapy.
Journal ArticleDOI
Multidisciplinary approach of liver metastases from colorectal cancer.
TL;DR: It is recommended that all patients with CRLM be managed by a multidisciplinary approach (MDA) to select the best strategy and new treatment procedures may contribute to improve prognosis; hence, the necessity for MDA for the treatment of CRLm will further increase.
Journal ArticleDOI
Advances in resection and transplantation for hepatocellular carcinoma
TL;DR: The ability to readily cure hepatitis C stands out as the most impactful development in the field over recent years, especially in Western countries where hepatitis C has long been the chief aetiology underlying HCC and a predictor of poor outcomes after surgery.
Journal ArticleDOI
ALPPS Versus Portal Vein Embolization for Hepatitis-related Hepatocellular Carcinoma: A Changing Paradigm in Modulation of Future Liver Remnant Before Major Hepatectomy.
Albert C. Y. Chan,Wei Yi Zhang,Kenneth S. H. Chok,Jeff W.C. Dai,Ren Ji,Crystal Kwan,Nancy Kwan Man,Ronnie T.P. Poon,Chung Mau Lo +8 more
TL;DR: ALPPS conferred a higher resection rate in hepatitis-related HCC with comparable short- and long-term oncological outcome with PVE, and tumor immunohistochemical staining showed no difference in expression of PD-1, V-EGF, and AFP between ALPPS, Pve, and UH.
References
More filters
Journal ArticleDOI
Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.
Jacques Ferlay,Isabelle Soerjomataram,Rajesh Dikshit,Sultan Eser,Colin Mathers,Marise Souto Rebelo,Donald Maxwell Parkin,David Forman,Freddie Bray +8 more
TL;DR: The GLOBOCAN series of the International Agency for Research on Cancer (IARC) as mentioned in this paper provides estimates of the worldwide incidence and mortality from 27 major cancers and for all cancers combined for 2012.
Journal ArticleDOI
Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
TL;DR: The new complication classification appears reliable and may represent a compelling tool for quality assessment in surgery in all parts of the world.
Journal ArticleDOI
Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases
Jean Nicolas Vauthey,Timothy M. Pawlik,Dario Ribero,Tsung Teh Wu,Daria Zorzi,Paulo M. Hoff,Henry Q. Xiong,Cathy Eng,Gregory Y. Lauwers,Mari Mino-Kenudson,Mauro Risio,Andrea Muratore,Lorenzo Capussotti,Steven A. Curley,Eddie K. Abdalla +14 more
TL;DR: Steatohepatitis is associated with an increased 90-day mortality after hepatic surgery and the chemotherapy regimen should be carefully considered because the risk of hepatotoxicity is significant in patients with hepatic CRM.
Journal ArticleDOI
Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings.
Andreas A. Schnitzbauer,Sven A. Lang,H. Goessmann,Silvio Nadalin,Janine Baumgart,Stefan Farkas,Stefan Fichtner-Feigl,Thomas Lorf,Armin Goralcyk,Rüdiger Hörbelt,Alexander Kroemer,Martin Loss,Petra Rümmele,Marcus N. Scherer,Winfried Padberg,Alfred Königsrainer,Hauke Lang,Aiman Obed,Hans J. Schlitt +18 more
TL;DR: Two-step hepatic resection performing surgical exploration, PVL, and ISS results in a marked and rapid hypertrophy of functional liver tissue and enables curative resection of marginally resectable liver tumors or metastases in patients that might otherwise be regarded as palliative.
Related Papers (5)
Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings.
Andreas A. Schnitzbauer,Sven A. Lang,H. Goessmann,Silvio Nadalin,Janine Baumgart,Stefan Farkas,Stefan Fichtner-Feigl,Thomas Lorf,Armin Goralcyk,Rüdiger Hörbelt,Alexander Kroemer,Martin Loss,Petra Rümmele,Marcus N. Scherer,Winfried Padberg,Alfred Königsrainer,Hauke Lang,Aiman Obed,Hans J. Schlitt +18 more
Early survival and safety of ALPPS first report of the international ALPPS registry
Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)
Nuh N. Rahbari,O. James Garden,Robert Padbury,Mark Brooke-Smith,Michael Crawford,René Adam,Moritz Koch,Masatoshi Makuuchi,Ronald P. DeMatteo,Christopher Christophi,Simon W. Banting,Val Usatoff,Masato Nagino,Guy J. Maddern,Thomas J. Hugh,Jean Nicolas Vauthey,Paul D. Greig,Myrddin Rees,Yukihiro Yokoyama,Sheung Tat Fan,Yuji Nimura,Joan Figueras,Lorenzo Capussotti,Markus W. Büchler,Jürgen Weitz +24 more