Michael Linecker1, Patryk Kambakamba1, Dimitri A Raptis2, Massimo Malagó2, Francesca Ratti3, Luca Aldrighetti3, Ricardo Robles-Campos4, Nadja Lehwald-Tywuschik5, Wolfram T Knoefel5, Deniz Balci6, Victoria Ardiles7, Eduardo De Santibañes7, Stéphanie Truant8, Francois-René Pruvot8, Gregor A Stavrou9, Karl J Oldhafer9, Sergey Voskanyan10, Basant Mahadevappa11, Ivan Kozyrin12, Jee K Low13, Valentina Ferrri14, Emilio Vicente14, Andreas Prachalias15, Michail Pizanias15, Ashley K Clift16, Henrik Petrowsky1, Pierre-Alain Clavien1, Andrea Frilling17. 1. Swiss HPB and Transplantation Center, Department of Surgery, University Hospital Zurich, Switzerland. 2. Department of HPB- and Liver Transplantation Surgery, University College London, Royal Free Hospitals, London, UK. 3. Hepatobiliary Surgery Division, Department of Surgery, IRCCS San Raffaele Hospital, School of Medicine, Milan, Italy. 4. Department of Surgery and Liver and Pancreas Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB-Arrixaca, Murcia, Spain. 5. Department of Surgery, University Hospital Düsseldorf, Düsseldorf, Germany. 6. Department of Surgery, Ankara University, Ankara, Turkey. 7. Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Italian Hospital Buenos Aires, Argentina. 8. Department of Digestive Surgery and Transplantation, University Hospital, Lille, France. 9. Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany; Semmelweis University Budapest, Campus Hamburg, Germany. 10. Department of Surgery, A.I. Burnazyan FMBC Russian State Scientific Center of FMBA, Moscow, Russia. 11. Department of HPB and Liver Transplantation, HCG Hospitals, Bangalore, India. 12. Department of Thoracic and Abdominal Surgery and Oncology, Clinical Hospital #1 MEDSI, Moscow, Russia. 13. Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore. 14. General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Madrid, Spain. 15. Institute of Liver Studies, King's College Hospital, London, UK. 16. Department of Surgery and Cancer, Imperial College London, London, UK. 17. Department of Surgery and Cancer, Imperial College London, London, UK. Electronic address: a.frilling@imperial.ac.uk.
Abstract
BACKGROUND: Surgery is the most effective treatment option for neuroendocrine liver metastases (NELM). This study investigated the role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as a novel strategy in treatment of NELM. METHODS: The International ALPPS Registry was reviewed to study patients who underwent ALPPS for NELM. RESULTS: From 2010 to 2017, 954 ALPPS procedures from 135 international centers were recorded in the International ALPPS Registry. Of them, 24 (2.5%) were performed for NELM. Twenty-one patients entered the final analysis. Overall grade ≥3b morbidity was 9% after stage 1 and 27% after stage 2. Ninety-day mortality was 5%. R0 resection was achieved in 19 cases (90%) at stage 2. Median follow-up was 28 (19-48) months. Median disease free survival (DFS) was 17.3 (95% CI: 7.1-27.4) months, 1-year and 2-year DFS was 73.2% and 41.8%, respectively. Median overall survival (OS) was not reached. One-year and 2-year OS was 95.2% and 95.2%, respectively. CONCLUSIONS: ALPPS appears to be a suitable strategy for inclusion in the multimodal armamentarium of well-selected patients with neuroendocrine liver metastases. In light of the morbidity in this initial series and a high rate of disease-recurrence, the procedure should be taken with caution.
BACKGROUND: Surgery is the most effective treatment option for neuroendocrine liver metastases (NELM). This study investigated the role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as a novel strategy in treatment of NELM. METHODS: The International ALPPS Registry was reviewed to study patients who underwent ALPPS for NELM. RESULTS: From 2010 to 2017, 954 ALPPS procedures from 135 international centers were recorded in the International ALPPS Registry. Of them, 24 (2.5%) were performed for NELM. Twenty-one patients entered the final analysis. Overall grade ≥3b morbidity was 9% after stage 1 and 27% after stage 2. Ninety-day mortality was 5%. R0 resection was achieved in 19 cases (90%) at stage 2. Median follow-up was 28 (19-48) months. Median disease free survival (DFS) was 17.3 (95% CI: 7.1-27.4) months, 1-year and 2-year DFS was 73.2% and 41.8%, respectively. Median overall survival (OS) was not reached. One-year and 2-year OS was 95.2% and 95.2%, respectively. CONCLUSIONS: ALPPS appears to be a suitable strategy for inclusion in the multimodal armamentarium of well-selected patients with neuroendocrine liver metastases. In light of the morbidity in this initial series and a high rate of disease-recurrence, the procedure should be taken with caution.
Authors: Henrik Petrowsky; Ralph Fritsch; Matthias Guckenberger; Michelle L De Oliveira; Philipp Dutkowski; Pierre-Alain Clavien Journal: Nat Rev Gastroenterol Hepatol Date: 2020-07-17 Impact factor: 46.802
Authors: Philip C Müller; Michael Linecker; Elvan O Kirimker; Christian E Oberkofler; Pierre-Alain Clavien; Deniz Balci; Henrik Petrowsky Journal: Langenbecks Arch Surg Date: 2021-03-19 Impact factor: 3.445