Early survival and safety of ALPPS first report of the international ALPPS registry

Erik Schadde; Victoria Ardiles; Ricardo Robles-Campos; Massimo Malago; Marcel Machado; Roberto Hernandez-Alejandro; Olivier Soubrane; Andreas A. Schnitzbauer; Dimitri Raptis; Christoph Tschuor; Henrik Petrowsky; Eduardo De Santibanes; Pierre Alain Clavien; Eddie Abdalla; Rene Adam; Dmitri Alden; Luca Antonio Aldrighetti; Emilio Alvarez Prida De Paz; Silvio Balzan; Jeffrey Barkun; Bergthor Björnsson; Carlos Castro-Benitez; Raffaele Brustia; William C. Chapman; Nikita Chardarov; Denis Chaychenko; Daniel Cherqui; Laura Corradetti; Kris Croome; Esteban Cugat; Jiahong Dong; Vincent Donckier; Alexandre Doussot; Marcelo Enne; Joan Figueras; Erik Herrero Fonollosa; Riccardo Gauzolino; Thomas Gruenberger; Xavier Maximilien Keutgen; Alan Koffron; Norihiro Kukudo; Javier Lendoire; Jun Li; J. Peter A. Lodge; Susan Logan; Dario Lorenzin; Valerio Lucidi; Georg Lurje; Michele Masetti; Lucas McCormack; Roberto Montalti; Masato Nagino; Natascha Nüssler; Klinikum Neuperlach; Pablo Ortega-Deballon; Karen Pineda; Theodora Pissanou; Francesca Ratti; Jean Marc Regimbeau; Xavier Rogiers; Yoshihiro Sakamoto; Per Sandström; Julio Santoyo; Olivier Scatton; Gregory Sergeant; Alejandro Serrablo; Dinesh Sharma; Oleg Skipenko; Evgeny Solomonov; Ernesto Sparrelid; Stojanovic Stojanovic; Steven Strassberg; Hans Torrenga; Roberto Troisi; Stéphanie Truant; Neeta Vachharajani; Eduardo Viana De Carvalho; Eric Vibert; Emilio Vicente; Marco Vivarelli; Soumil Vyas; Zhang Wen; Wang Zheng; Jian Zhou

doi:10.1097/SLA.0000000000000947

Early survival and safety of ALPPS first report of the international ALPPS registry

Erik Schadde, Victoria Ardiles, Ricardo Robles-Campos, Massimo Malago, Marcel Machado, Roberto Hernandez-Alejandro, Olivier Soubrane, Andreas A. Schnitzbauer, Dimitri Raptis, Christoph Tschuor, Henrik Petrowsky, Eduardo De Santibanes, Pierre Alain Clavien, Eddie Abdalla, Rene Adam, Dmitri Alden, Luca Antonio Aldrighetti, Emilio Alvarez Prida De Paz, Silvio Balzan, Jeffrey BarkunBergthor Björnsson, Carlos Castro-Benitez, Raffaele Brustia, William C. Chapman, Nikita Chardarov, Denis Chaychenko, Daniel Cherqui, Laura Corradetti, Kris Croome, Esteban Cugat, Jiahong Dong, Vincent Donckier, Alexandre Doussot, Marcelo Enne, Joan Figueras, Erik Herrero Fonollosa, Riccardo Gauzolino, Thomas Gruenberger, Xavier Maximilien Keutgen, Alan Koffron, Norihiro Kukudo, Javier Lendoire, Jun Li, J. Peter A. Lodge, Susan Logan, Dario Lorenzin, Valerio Lucidi, Georg Lurje, Michele Masetti, Lucas McCormack, Roberto Montalti, Masato Nagino, Natascha Nüssler, Klinikum Neuperlach, Pablo Ortega-Deballon, Karen Pineda, Theodora Pissanou, Francesca Ratti, Jean Marc Regimbeau, Xavier Rogiers, Yoshihiro Sakamoto, Per Sandström, Julio Santoyo, Olivier Scatton, Gregory Sergeant, Alejandro Serrablo, Dinesh Sharma, Oleg Skipenko, Evgeny Solomonov, Ernesto Sparrelid, Stojanovic Stojanovic, Steven Strassberg, Hans Torrenga, Roberto Troisi, Stéphanie Truant, Neeta Vachharajani, Eduardo Viana De Carvalho, Eric Vibert, Emilio Vicente, Marco Vivarelli, Soumil Vyas, Zhang Wen, Wang Zheng, Jian Zhou

Transplant Surgery

Research output: Contribution to journal › Article › peer-review

264 Scopus citations

Abstract

Objectives: To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry. Background: ALPPS induces accelerated growth of small future liver remnants (FLR) to allow curative resection of liver tumors. There is concern about safety based on reports of higher morbidity and mortality. Methods: A Web-based data entry system was created with password access and data pseudoencryption (NCT01924741). All patients with complete 90-day data were included. Multivariate logistic regression analysis was performed to identify independent risk factors for severe complications and mortality and volume growth of the FLR. Results: Complete data were available for 202 patients. A total of 141 (70%) patients had colorectal liver metastases (CRLM). Median starting standardized future liver remnants of 21% increased by 80% within a median of 7 days. Ninety-day mortality was 19/202 (9%). Severe complications including mortalities (Clavien-Dindo ≥IIIb) occurred in 27% of patients. Independent factors for severe complications were red blood cell transfusion [odds ratio (OR), 5.2), ALPPS stage I operating time greater than 300 minutes (OR, 4.4), age more than 60 years (OR, 3.8), and non-CRLM (OR, 2.7). Age, use of Pringle maneuver, and histologic changes led to less volume growth. In patients younger than 60 years with CRLM, 90-day mortality was similar to conventional 2-stage hepatectomies for CRLM. Conclusions: This is the first analysis of the ALPPS registry showing that ALPPS has increased perioperative morbidity and mortality in older patients but better outcomes in patients with CRLM.

Original language	English (US)
Pages (from-to)	829-838
Number of pages	10
Journal	Annals of surgery
Volume	260
Issue number	5
DOIs	https://doi.org/10.1097/SLA.0000000000000947
State	Published - 2014

Keywords

Alpps
Hepatectomy
Hypertrophy
Liver tumors
Portal vein (qualifier surgery)

ASJC Scopus subject areas

Surgery

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10.1097/SLA.0000000000000947

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Schadde, E., Ardiles, V., Robles-Campos, R., Malago, M., Machado, M., Hernandez-Alejandro, R., Soubrane, O., Schnitzbauer, A. A., Raptis, D., Tschuor, C., Petrowsky, H., De Santibanes, E., Clavien, P. A., Abdalla, E., Adam, R., Alden, D., Aldrighetti, L. A., De Paz, E. A. P., Balzan, S., ... Zhou, J. (2014). Early survival and safety of ALPPS first report of the international ALPPS registry. Annals of surgery, 260(5), 829-838. https://doi.org/10.1097/SLA.0000000000000947

Schadde, E, Ardiles, V, Robles-Campos, R, Malago, M, Machado, M, Hernandez-Alejandro, R, Soubrane, O, Schnitzbauer, AA, Raptis, D, Tschuor, C, Petrowsky, H, De Santibanes, E, Clavien, PA, Abdalla, E, Adam, R, Alden, D, Aldrighetti, LA, De Paz, EAP, Balzan, S, Barkun, J, Björnsson, B, Castro-Benitez, C, Brustia, R, Chapman, WC, Chardarov, N, Chaychenko, D, Cherqui, D, Corradetti, L, Croome, K, Cugat, E, Dong, J, Donckier, V, Doussot, A, Enne, M, Figueras, J, Fonollosa, EH, Gauzolino, R, Gruenberger, T, Keutgen, XM, Koffron, A, Kukudo, N, Lendoire, J, Li, J, Lodge, JPA, Logan, S, Lorenzin, D, Lucidi, V, Lurje, G, Masetti, M, McCormack, L, Montalti, R, Nagino, M, Nüssler, N, Neuperlach, K, Ortega-Deballon, P, Pineda, K, Pissanou, T, Ratti, F, Regimbeau, JM, Rogiers, X, Sakamoto, Y, Sandström, P, Santoyo, J, Scatton, O, Sergeant, G, Serrablo, A, Sharma, D, Skipenko, O, Solomonov, E, Sparrelid, E, Stojanovic, S, Strassberg, S, Torrenga, H, Troisi, R, Truant, S, Vachharajani, N, De Carvalho, EV, Vibert, E, Vicente, E, Vivarelli, M, Vyas, S, Wen, Z, Zheng, W & Zhou, J 2014, 'Early survival and safety of ALPPS first report of the international ALPPS registry', Annals of surgery, vol. 260, no. 5, pp. 829-838. https://doi.org/10.1097/SLA.0000000000000947

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title = "Early survival and safety of ALPPS first report of the international ALPPS registry",

abstract = "Objectives: To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry. Background: ALPPS induces accelerated growth of small future liver remnants (FLR) to allow curative resection of liver tumors. There is concern about safety based on reports of higher morbidity and mortality. Methods: A Web-based data entry system was created with password access and data pseudoencryption (NCT01924741). All patients with complete 90-day data were included. Multivariate logistic regression analysis was performed to identify independent risk factors for severe complications and mortality and volume growth of the FLR. Results: Complete data were available for 202 patients. A total of 141 (70%) patients had colorectal liver metastases (CRLM). Median starting standardized future liver remnants of 21% increased by 80% within a median of 7 days. Ninety-day mortality was 19/202 (9%). Severe complications including mortalities (Clavien-Dindo ≥IIIb) occurred in 27% of patients. Independent factors for severe complications were red blood cell transfusion [odds ratio (OR), 5.2), ALPPS stage I operating time greater than 300 minutes (OR, 4.4), age more than 60 years (OR, 3.8), and non-CRLM (OR, 2.7). Age, use of Pringle maneuver, and histologic changes led to less volume growth. In patients younger than 60 years with CRLM, 90-day mortality was similar to conventional 2-stage hepatectomies for CRLM. Conclusions: This is the first analysis of the ALPPS registry showing that ALPPS has increased perioperative morbidity and mortality in older patients but better outcomes in patients with CRLM.",

keywords = "Alpps, Hepatectomy, Hypertrophy, Liver tumors, Portal vein (qualifier surgery)",

author = "Erik Schadde and Victoria Ardiles and Ricardo Robles-Campos and Massimo Malago and Marcel Machado and Roberto Hernandez-Alejandro and Olivier Soubrane and Schnitzbauer, {Andreas A.} and Dimitri Raptis and Christoph Tschuor and Henrik Petrowsky and {De Santibanes}, Eduardo and Clavien, {Pierre Alain} and Eddie Abdalla and Rene Adam and Dmitri Alden and Aldrighetti, {Luca Antonio} and {De Paz}, {Emilio Alvarez Prida} and Silvio Balzan and Jeffrey Barkun and Bergthor Bj{\"o}rnsson and Carlos Castro-Benitez and Raffaele Brustia and Chapman, {William C.} and Nikita Chardarov and Denis Chaychenko and Daniel Cherqui and Laura Corradetti and Kris Croome and Esteban Cugat and Jiahong Dong and Vincent Donckier and Alexandre Doussot and Marcelo Enne and Joan Figueras and Fonollosa, {Erik Herrero} and Riccardo Gauzolino and Thomas Gruenberger and Keutgen, {Xavier Maximilien} and Alan Koffron and Norihiro Kukudo and Javier Lendoire and Jun Li and Lodge, {J. Peter A.} and Susan Logan and Dario Lorenzin and Valerio Lucidi and Georg Lurje and Michele Masetti and Lucas McCormack and Roberto Montalti and Masato Nagino and Natascha N{\"u}ssler and Klinikum Neuperlach and Pablo Ortega-Deballon and Karen Pineda and Theodora Pissanou and Francesca Ratti and Regimbeau, {Jean Marc} and Xavier Rogiers and Yoshihiro Sakamoto and Per Sandstr{\"o}m and Julio Santoyo and Olivier Scatton and Gregory Sergeant and Alejandro Serrablo and Dinesh Sharma and Oleg Skipenko and Evgeny Solomonov and Ernesto Sparrelid and Stojanovic Stojanovic and Steven Strassberg and Hans Torrenga and Roberto Troisi and St{\'e}phanie Truant and Neeta Vachharajani and {De Carvalho}, {Eduardo Viana} and Eric Vibert and Emilio Vicente and Marco Vivarelli and Soumil Vyas and Zhang Wen and Wang Zheng and Jian Zhou",

note = "Publisher Copyright: Copyright {\textcopyright} 2014 by Lippincott Williams & Wilkins.",

year = "2014",

doi = "10.1097/SLA.0000000000000947",

language = "English (US)",

volume = "260",

pages = "829--838",

journal = "Annals of surgery",

issn = "0003-4932",

publisher = "Lippincott Williams and Wilkins",

number = "5",

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TY - JOUR

T1 - Early survival and safety of ALPPS first report of the international ALPPS registry

AU - Schadde, Erik

AU - Ardiles, Victoria

AU - Robles-Campos, Ricardo

AU - Malago, Massimo

AU - Machado, Marcel

AU - Hernandez-Alejandro, Roberto

AU - Soubrane, Olivier

AU - Schnitzbauer, Andreas A.

AU - Raptis, Dimitri

AU - Tschuor, Christoph

AU - Petrowsky, Henrik

AU - De Santibanes, Eduardo

AU - Clavien, Pierre Alain

AU - Abdalla, Eddie

AU - Adam, Rene

AU - Alden, Dmitri

AU - Aldrighetti, Luca Antonio

AU - De Paz, Emilio Alvarez Prida

AU - Balzan, Silvio

AU - Barkun, Jeffrey

AU - Björnsson, Bergthor

AU - Castro-Benitez, Carlos

AU - Brustia, Raffaele

AU - Chapman, William C.

AU - Chardarov, Nikita

AU - Chaychenko, Denis

AU - Cherqui, Daniel

AU - Corradetti, Laura

AU - Croome, Kris

AU - Cugat, Esteban

AU - Dong, Jiahong

AU - Donckier, Vincent

AU - Doussot, Alexandre

AU - Enne, Marcelo

AU - Figueras, Joan

AU - Fonollosa, Erik Herrero

AU - Gauzolino, Riccardo

AU - Gruenberger, Thomas

AU - Keutgen, Xavier Maximilien

AU - Koffron, Alan

AU - Kukudo, Norihiro

AU - Lendoire, Javier

AU - Li, Jun

AU - Lodge, J. Peter A.

AU - Logan, Susan

AU - Lorenzin, Dario

AU - Lucidi, Valerio

AU - Lurje, Georg

AU - Masetti, Michele

AU - McCormack, Lucas

AU - Montalti, Roberto

AU - Nagino, Masato

AU - Nüssler, Natascha

AU - Neuperlach, Klinikum

AU - Ortega-Deballon, Pablo

AU - Pineda, Karen

AU - Pissanou, Theodora

AU - Ratti, Francesca

AU - Regimbeau, Jean Marc

AU - Rogiers, Xavier

AU - Sakamoto, Yoshihiro

AU - Sandström, Per

AU - Santoyo, Julio

AU - Scatton, Olivier

AU - Sergeant, Gregory

AU - Serrablo, Alejandro

AU - Sharma, Dinesh

AU - Skipenko, Oleg

AU - Solomonov, Evgeny

AU - Sparrelid, Ernesto

AU - Stojanovic, Stojanovic

AU - Strassberg, Steven

AU - Torrenga, Hans

AU - Troisi, Roberto

AU - Truant, Stéphanie

AU - Vachharajani, Neeta

AU - De Carvalho, Eduardo Viana

AU - Vibert, Eric

AU - Vicente, Emilio

AU - Vivarelli, Marco

AU - Vyas, Soumil

AU - Wen, Zhang

AU - Zheng, Wang

AU - Zhou, Jian

PY - 2014

Y1 - 2014

N2 - Objectives: To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry. Background: ALPPS induces accelerated growth of small future liver remnants (FLR) to allow curative resection of liver tumors. There is concern about safety based on reports of higher morbidity and mortality. Methods: A Web-based data entry system was created with password access and data pseudoencryption (NCT01924741). All patients with complete 90-day data were included. Multivariate logistic regression analysis was performed to identify independent risk factors for severe complications and mortality and volume growth of the FLR. Results: Complete data were available for 202 patients. A total of 141 (70%) patients had colorectal liver metastases (CRLM). Median starting standardized future liver remnants of 21% increased by 80% within a median of 7 days. Ninety-day mortality was 19/202 (9%). Severe complications including mortalities (Clavien-Dindo ≥IIIb) occurred in 27% of patients. Independent factors for severe complications were red blood cell transfusion [odds ratio (OR), 5.2), ALPPS stage I operating time greater than 300 minutes (OR, 4.4), age more than 60 years (OR, 3.8), and non-CRLM (OR, 2.7). Age, use of Pringle maneuver, and histologic changes led to less volume growth. In patients younger than 60 years with CRLM, 90-day mortality was similar to conventional 2-stage hepatectomies for CRLM. Conclusions: This is the first analysis of the ALPPS registry showing that ALPPS has increased perioperative morbidity and mortality in older patients but better outcomes in patients with CRLM.

AB - Objectives: To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry. Background: ALPPS induces accelerated growth of small future liver remnants (FLR) to allow curative resection of liver tumors. There is concern about safety based on reports of higher morbidity and mortality. Methods: A Web-based data entry system was created with password access and data pseudoencryption (NCT01924741). All patients with complete 90-day data were included. Multivariate logistic regression analysis was performed to identify independent risk factors for severe complications and mortality and volume growth of the FLR. Results: Complete data were available for 202 patients. A total of 141 (70%) patients had colorectal liver metastases (CRLM). Median starting standardized future liver remnants of 21% increased by 80% within a median of 7 days. Ninety-day mortality was 19/202 (9%). Severe complications including mortalities (Clavien-Dindo ≥IIIb) occurred in 27% of patients. Independent factors for severe complications were red blood cell transfusion [odds ratio (OR), 5.2), ALPPS stage I operating time greater than 300 minutes (OR, 4.4), age more than 60 years (OR, 3.8), and non-CRLM (OR, 2.7). Age, use of Pringle maneuver, and histologic changes led to less volume growth. In patients younger than 60 years with CRLM, 90-day mortality was similar to conventional 2-stage hepatectomies for CRLM. Conclusions: This is the first analysis of the ALPPS registry showing that ALPPS has increased perioperative morbidity and mortality in older patients but better outcomes in patients with CRLM.

KW - Alpps

KW - Hepatectomy

KW - Hypertrophy

KW - Liver tumors

KW - Portal vein (qualifier surgery)

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JO - Annals of surgery

JF - Annals of surgery

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ER -

Early survival and safety of ALPPS first report of the international ALPPS registry

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