Pim B Olthof1, Joost Huiskens2, Dennis A Wicherts2, Pablo E Huespe3, Victoria Ardiles3, Ricardo Robles-Campos4, René Adam5, Michael Linecker6, Pierre-Alain Clavien6, Miriam Koopman7, Cornelis Verhoef8, Cornelis J A Punt9, Thomas M van Gulik2, Eduardo de Santibanes3. 1. Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: p.b.olthof@amc.nl. 2. Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands. 3. Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 4. Servicio de Cirugía General y Aparato Digestivo, Virgen de la Arrixaca University Hospital, Murcia, Spain. 5. Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France. 6. Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Switzerland. 7. Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands. 8. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. 9. Department of Medical Oncology, Academic Medical Center, Amsterdam, the Netherlands.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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: Arezou Abbasi; Amir A Rahnemai-Azar; Katiuscha Merath; Sharon M Weber; Daniel E Abbott; Mary Dillhoff; Jordan Cloyd; Timothy M Pawlik Journal: Transl Gastroenterol Hepatol Date: 2018-09-17
Authors: Jan Bednarsch; Zoltan Czigany; Samara Sharmeen; Gregory van der Kroft; Pavel Strnad; Tom Florian Ulmer; Peter Isfort; Philipp Bruners; Georg Lurje; Ulf Peter Neumann Journal: World J Surg Oncol Date: 2020-06-24 Impact factor: 2.754