title: Patient Survival After Simultaneous ALPPS and Colorectal Resection.
abstract: Liver resection combined with colorectal surgery (CRS) is the only curative option in many patients presenting with synchronous colorectal cancer and liver metastases (CRLM). Simultaneous resection has been shown to offer benefits in patients with low hepatic tumor load; however, in the setting of in situ colorectal tumor with extensive CRLM and a small predicted future liver remnant (FLR), the use of simultaneous ALPPS and CRS is controversial, lacking outcome data.
  
  
  
  Thirty-one cases of simultaneous ALPPS and CRS prospectively entered into the International ALPPS Registry were examined. Univariate analysis was used to identify factors associated with 90-day mortality after stage-2.
  
  
  
  Thirty patients (97%) completed both stages. CRS was performed during stage-1 in 22 patients (73%). Seven patients (23%) had severe complications (Clavien-Dindo ≥ IIIb) following stage-2 ALPPS. The 90-day mortality rate was 15%. Patients who had a severe complication after stage-1 were significantly more likely to have 90-day mortality following stage-2 (p = 0.002). MELD score > 10 on postoperative day-5 after stage-1 was also significantly associated with 90-day mortality (p = 0.011). Disease-free survival and overall survival were 36% and 76% at 1 year, respectively.
  
  
  
  In light of the high mortality and poor long-term survival identified in this series, the adoption of ALPPS with CRS cannot be recommended without further data. Patients who suffer severe complications or have an elevated MELD score after stage-1 are at higher risk of mortality following stage-2.
authors.affiliation: Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
authors.forename: Kerollos Nashat
authors.initials: KN
authors.lastname: Wanis
authors.affiliation: Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
authors.forename: Suzana
authors.initials: S
authors.lastname: Buac
authors.affiliation: Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Linecker
authors.affiliation: Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina.
authors.forename: Victoria
authors.initials: V
authors.lastname: Ardiles
authors.affiliation: Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.|Multi-Organ Transplant Program, London Health Sciences Center, London, ON, Canada.
authors.forename: Mauro Enrique
authors.initials: ME
authors.lastname: Tun-Abraham
authors.affiliation: Department of General Surgery, Liver Transplant Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Robles-Campos
authors.affiliation: Department of HPB and Liver Transplant Surgery, Royal Free Hospital, University College London, London, UK.
authors.forename: Massimo
authors.initials: M
authors.lastname: Malago
authors.affiliation: Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
authors.affiliation: Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: Division of Hepatobiliary Surgery and Transplantation, Department of Surgery, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA. Roberto_Hernandez@urmc.rochester.edu.
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernandez-Alejandro
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008026:Ligation; D008099:Liver / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D012042:Registries; D016019:Survival Analysis