Guido Torzilli1, Matteo Serenari2, Luca Viganò1, Matteo Cimino1, Claudia Benini3, Marco Massani4, Giuseppe M Ettorre5, Matteo Cescon2, Alessandro Ferrero6, Umberto Cillo7, Luca Aldrighetti8, Elio Jovine9. 1. Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University and Research Hospital, Rozzano-Milan, Italy. 2. Department of Medical and Surgical Sciences, General Surgery and Transplantation Unit, University of Bologna, Italy. 3. Department of General Surgery, Maggiore Hospital, Bologna, Italy. 4. Regional Center for HPB Surgery, Regional Hospital of Treviso, Treviso, Italy. 5. Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy. 6. Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy. 7. Hepatobiliary and Liver Transplantation Unit, University of Padua, Padua, Italy. 8. Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy. 9. Department of General Surgery, Maggiore Hospital, Bologna, Italy. Electronic address: elio.jovine@ausl.bologna.it.
Abstract
BACKGROUND: In case of bilobar colorectal liver metastases (CLM) associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been proposed. Enhanced one-stage ultrasound-guided hepatectomy (e-OSH) may represent a further solution for these patients. Aim of this study was to compare by case-match analyses the outcome of ALPPS and e-OSH. METHODS: Between 2012 and 2017, patients undergoing ALPPS for bilobar CLM were matched 1:2 with patients receiving e-OSH. Patients were matched according to the Fong Score (1-3/4-5), the number of CLM (3-7/≥8), the number of CLM in the left liver (1-2/≥3) and preoperative chemotherapy. All the patients in the e-OSH group had a right -sided major vascular contact. The main endpoints of the study were perioperative outcomes, overall (OS) and disease-free survival (DFS). RESULTS: Seventy-eight patients were selected (26 ALPPS and 52 e-OSH) based on matching process. The two treatments differed significantly in major morbidity (26.9% ALPPS vs 7.7% e-OSH, p = 0.017). Median OS (31.7 vs 32.6 months) and DFS (10.6 vs 7.8 months) were comparable between the two groups. CONCLUSIONS: This study demonstrates that ALPPS and e-OSH for bilobar CLM achieve comparable long-term results, despite higher morbidity reported after ALPPS. These findings should drive to reposition e-OSH in managing these patients.
BACKGROUND: In case of bilobar colorectal liver metastases (CLM) associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been proposed. Enhanced one-stage ultrasound-guided hepatectomy (e-OSH) may represent a further solution for these patients. Aim of this study was to compare by case-match analyses the outcome of ALPPS and e-OSH. METHODS: Between 2012 and 2017, patients undergoing ALPPS for bilobar CLM were matched 1:2 with patients receiving e-OSH. Patients were matched according to the Fong Score (1-3/4-5), the number of CLM (3-7/≥8), the number of CLM in the left liver (1-2/≥3) and preoperative chemotherapy. All the patients in the e-OSH group had a right -sided major vascular contact. The main endpoints of the study were perioperative outcomes, overall (OS) and disease-free survival (DFS). RESULTS: Seventy-eight patients were selected (26 ALPPS and 52 e-OSH) based on matching process. The two treatments differed significantly in major morbidity (26.9% ALPPS vs 7.7% e-OSH, p = 0.017). Median OS (31.7 vs 32.6 months) and DFS (10.6 vs 7.8 months) were comparable between the two groups. CONCLUSIONS: This study demonstrates that ALPPS and e-OSH for bilobar CLM achieve comparable long-term results, despite higher morbidity reported after ALPPS. These findings should drive to reposition e-OSH in managing these patients.
Authors: Gabriel D Ivey; Fabian M Johnston; Nilofer S Azad; Eric S Christenson; Kelly J Lafaro; Christopher R Shubert Journal: Cancers (Basel) Date: 2022-02-20 Impact factor: 6.639