Early survival and safety of ALPPS: first report of the International ALPPS Registry.
OBJECTIVE
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.
*Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland †Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina ‡Department of General Surgery, Liver Transplant Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain §Department of HPB and Liver Transplant Surgery, Royal Free Hospital, University College London, London, United Kingdom ¶Department of Surgery, Sirio Libanes Hospital, University of Sao Paolo, Sao Paolo, Brazil ‖Department of Surgery, Division of HPB Surgery, Western University Medical Center, London, Ontario, Canada **Department of HPB Surgery and Liver Transplantation, St. Antoine Hospital, Paris, France ††Department of Visceral- and Transplantation Surgery, Johann Wolfgang von Goethe University, Frankfurt, Germany. §§Hospital Paul Brousse, Université Paris Sud, Paris, France.
Erik
E
Schadde
Victoria
V
Ardiles
Ricardo
R
Robles-Campos
Massimo
M
Malago
Marcel
M
Machado
Roberto
R
Hernandez-Alejandro
Olivier
O
Soubrane
Andreas A
AA
Schnitzbauer
Dimitri
D
Raptis
Christoph
C
Tschuor
Henrik
H
Petrowsky
Eduardo
E
De Santibanes
Pierre-Alain
PA
Clavien
D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate