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Multicenter Study
. 2020 Nov;272(5):793-800.
doi: 10.1097/SLA.0000000000004330.

First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases

Henrik Petrowsky  1 , Michael Linecker  1 , Dimitri A Raptis  2 , Christoph Kuemmerli  1 , Ralph Fritsch  3 , Onur E Kirimker  4 , Deniz Balci  4 , Francesca Ratti  5 , Luca Aldrighetti  5 , Sergey Voskanyan  6 , Federico Tomassini  7 , Roberto I Troisi  7   8 , Jan Bednarsch  9 , Georg Lurje  9   10 , Mohammad-Hossein Fard-Aghaie  11   12 , Tim Reese  11   12 , Karl J Oldhafer  11   12 , Omid Ghamarnejad  13 , Arianeb Mehrabi  13 , Mauro E Tun Abraham  14 , Stéphanie Truant  15 , Francois-René Pruvot  15 , Emir Hoti  16 , Patryk Kambakamba  16 , Ivan Capobianco  17 , Silvio Nadalin  17 , Eduardo S M Fernandes  18   19 , Philipp Kron  1   20 , Peter Lodge  20 , Pim B Olthof  21 , Thomas van Gulik  21 , Carlos Castro-Benitez  22 , René Adam  22 , Marcel Autran Machado  23 , Martin Teutsch  24 , Jun Li  24 , Marcus N Scherer  25 , Hans J Schlitt  25 , Victoria Ardiles  26 , Eduardo de Santibañes  26 , Roberto Brusadin  27 , Victor Lopez-Lopez  27 , Ricardo Robles-Campos  27 , Massimo Malagó  2 , Roberto Hernandez-Alejandro  14   28 , Pierre-Alain Clavien  1
Affiliations
Multicenter Study

First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases

Henrik Petrowsky et al. Ann Surg. 2020 Nov.

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.

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