Ivan Capobianco1, Karl J Oldhafer2, Mohammed-Hossein Fard-Aghaie2, Ricardo Robles-Campos3, Roberto Brusadin3, Henrik Petrowsky4, Michael Linecker4, Arianeb Mehrabi5, Katrin Hoffmann5, Jun Li6, Asmus Heumann6, Roberto Hernandez-Alejandro7, Mauro Enrique Tun-Abraham8, Elio Jovine9, Matteo Serenari10, Bergthor Bjornsson11, Per Sandström11, Ruslan Alikhanov12, Mikhail Efanov12, Paolo Muiesan13, Andrea Schlegel13, Thomas M van Gulik14, Pim B Olthof14, Gregor Alexander Stavrou15, Lina Maria Serna-Higuita16, Alfred Königsrainer1, Silvio Nadalin1. 1. Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany. 2. Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany. 3. Department of Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain. 4. Swiss HPB and Transplantation Center, Department of Surgery, Zurich University Hospital, Zurich, Switzerland. 5. Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. 6. General, Visceral and Thoracic Surgery Department and Clinic, Hamburg-Eppendorf University Medical Center, Hamburg, Germany. 7. Division of Transplantation and Hepatobiliary Surgery, University of Rochester, Rochester, NY, USA. 8. Division of HPB Surgery and Liver Transplantation, Department of Surgery, London Health Sciences Centre, London, Canada. 9. General and Emergency Surgery Unit, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, Bologna, Italy. 10. General Surgery and Transplantation Unit, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy. 11. Department of Surgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. 12. Department of Hepatopancreatobiliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia. 13. Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 14. Department of Surgery, Amsterdam UMC (Location AMC), University of Amsterdam, Amsterdam, The Netherlands. 15. Department of General, Abdominal and Thoracic Surgery, Surgical Oncology, Saarbruecken General Hospital, Saarbruecken, Germany. 16. Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.
Abstract
Background: Preoperative patient selection in Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is not always reliable with currently available scores, particularly in patients with primary liver tumor. This study aims to (I) to determine whether comorbidities and patients characteristics are a risk factor in ALPPS and (II) to create a score predicting 90-day mortality preoperatively. Methods: Thirteen high-volume centers participated in this retrospective multicentric study. A risk analysis based on patient characteristics, underlying disease and procedure type was performed to identify risk factors and model the Comprehensive ALPPS Preoperative Risk Assessment (CAPRA) score. A nonparametric receiver operating characteristic analysis was performed to estimate the predictive ability of our score against the Charlson Comorbidity Index (CCI), the age-adjusted CCI (aCCI), the ALPPS risk score before Stage 1 (ALPPS-RS1) and Stage 2 (ALPPS-RS2). The model was internally validated applying bootstrapping. Results: A total of 451 patients were included. Mortality was 14.4%. The CAPRA score is calculated based on the following formula: (0.1 × age) - (2 × BSA) + 1 (in the presence of primary liver tumor) + 1 (in the presence of severe cardiovascular disease) + 2 (in the presence of moderate or severe diabetes) + 2 (in the presence of renal disease) + 2 (if classic ALPPS is planned). The predictive ability was 0.837 for the CAPRA score, 0.443 for CCI, 0.519 for aCCI, 0.693 for ALPPS-RS1 and 0.807 for ALPPS-RS2. After 1,000 cycles of bootstrapping the C statistic was 0.793. The accuracy plot revealed a cut-off for optimal prediction of postoperative mortality of 4.70. Conclusions: Comorbidities play an important role in ALPPS and should be carefully considered when planning the procedure. By assessing the patient's preoperative condition in relation to ALPPS, the CAPRA score has a very good ability to predict postoperative mortality. 2022 Hepatobiliary Surgery and Nutrition. All rights reserved.
Background: Preoperative patient selection in Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is not always reliable with currently available scores, particularly in patients with primary liver tumor. This study aims to (I) to determine whether comorbidities and patients characteristics are a risk factor in ALPPS and (II) to create a score predicting 90-day mortality preoperatively. Methods: Thirteen high-volume centers participated in this retrospective multicentric study. A risk analysis based on patient characteristics, underlying disease and procedure type was performed to identify risk factors and model the Comprehensive ALPPS Preoperative Risk Assessment (CAPRA) score. A nonparametric receiver operating characteristic analysis was performed to estimate the predictive ability of our score against the Charlson Comorbidity Index (CCI), the age-adjusted CCI (aCCI), the ALPPS risk score before Stage 1 (ALPPS-RS1) and Stage 2 (ALPPS-RS2). The model was internally validated applying bootstrapping. Results: A total of 451 patients were included. Mortality was 14.4%. The CAPRA score is calculated based on the following formula: (0.1 × age) - (2 × BSA) + 1 (in the presence of primary liver tumor) + 1 (in the presence of severe cardiovascular disease) + 2 (in the presence of moderate or severe diabetes) + 2 (in the presence of renal disease) + 2 (if classic ALPPS is planned). The predictive ability was 0.837 for the CAPRA score, 0.443 for CCI, 0.519 for aCCI, 0.693 for ALPPS-RS1 and 0.807 for ALPPS-RS2. After 1,000 cycles of bootstrapping the C statistic was 0.793. The accuracy plot revealed a cut-off for optimal prediction of postoperative mortality of 4.70. Conclusions: Comorbidities play an important role in ALPPS and should be carefully considered when planning the procedure. By assessing the patient's preoperative condition in relation to ALPPS, the CAPRA score has a very good ability to predict postoperative mortality. 2022 Hepatobiliary Surgery and Nutrition. All rights reserved.
Entities:
Keywords:
Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS); comorbidity; mortality; patient selection; prediction model
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