title: Survival after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for advanced colorectal liver metastases: A case-matched comparison with palliative systemic therapy.
abstract: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows the resection of colorectal liver metastases with curative intent which would otherwise be unresectable and only eligible for palliative systemic therapy. This study aimed to compare outcomes of ALPPS in patients with otherwise unresectable colorectal liver metastases with matched historic controls treated with palliative systemic treatment.
  
  
  
  All patients with colorectal liver metastases from the international ALPPS registry were identified and analyzed. Survival data were compared according to the extent of disease. Otherwise unresectable ALPPS patients were defined by at least 2 of the following criteria: ≥6 metastasis, ≥2 future remnant liver metastasis, ≥6 involved segments excluding segment 1. These patients were matched with patients included in 2, phase 3, metastatic, colorectal cancer trials (CAIRO and CAIRO2) using propensity scoring in order to compare survival.
  
  
  
  Of 295 patients with colorectal liver metastases in the ALPPS registry, 70 patients had otherwise unresectable disease defined by the proposed criteria. Two-year overall survival was 49% and 72% for patients with ≥2 and <2 criteria, respectively (P = .002). Median disease-free survival was 6 months compared to 12 months (P < .001) in the ≥2 and <2 criteria groups, respectively. Median overall survival was comparable between ALPPS patients with ≥2 criteria and case-matched patients who received palliative treatment (24.0 vs 17.6 months, P = .088).
  
  
  
  Early oncologic outcomes of patients with advanced liver metastases undergoing ALPPS were not superior to results of matched patients receiving systemic treatment with palliative intent. Careful patient selection is essential in order to improve outcomes.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: p.b.olthof@amc.nl.
authors.forename: Pim B
authors.initials: PB
authors.lastname: Olthof
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Huiskens
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wicherts
authors.affiliation: Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Pablo E
authors.initials: PE
authors.lastname: Huespe
authors.affiliation: Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Victoria
authors.initials: V
authors.lastname: Ardiles
authors.affiliation: Servicio de Cirugía General y Aparato Digestivo, Virgen de la Arrixaca University Hospital, Murcia, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Robles-Campos
authors.affiliation: Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.affiliation: Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Linecker
authors.affiliation: Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland.
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Miriam
authors.initials: M
authors.lastname: Koopman
authors.affiliation: Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.affiliation: Department of Medical Oncology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Cornelis J A
authors.initials: CJ
authors.lastname: Punt
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
authors.affiliation: Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibanes
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008026:Ligation / Q000379:methods; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D018579:Patient Selection; D011169:Portal Vein / Q000601:surgery; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome