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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.Ann Surg. 1999; 230 (discussion 18-21): 309-318
- Long-term survival following resection of colorectal hepatic metastases. Association Francaise de Chirurgie.Br J Surg. 1997; 84: 977-980
- Chemotherapy and surgery: new perspectives on the treatment of unresectable liver metastases.Ann Oncol. 2003; 14 (ii13-6)
- Bringing unresectable liver disease to resection with curative intent.Eur J Surg Oncol. 2007; 33: S42-S51
- Portal vein embolization and its effect on tumour progression for colorectal cancer liver metastases.Br J Surg. 2015; 102: 1240-1249
- Chemotherapy after portal vein embolization to protect against tumor growth during liver hypertrophy before hepatectomy.JAMA Surg. 2013; 148: 1103-1108
- Tumor progression after preoperative portal vein embolization.Ann Surg. 2012; 256 (discussion 7-8): 812-817
- Trends in long-term survival following liver resection for hepatic colorectal metastases.Ann Surg. 2002; 235: 759-766
- Hepatic resection for colorectal metastases: value for risk scoring systems?.Ann Surg. 2007; 246: 183-191
- Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution.J Am Coll Surg. 2010; 210 (752-5): 744-752
- Colorectal liver metastases: an update on palliative treatment options.J Gastrointestin Liver Dis. 2012; 21: 83-91
- Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy.J Clin Oncol. 2009; 27: 3677-3683
- Maintenance treatment with capecitabine and bevacizumab in metastatic colorectal cancer (CAIRO3): a phase 3 randomised controlled trial of the Dutch Colorectal Cancer Group.Lancet. 2015; 385: 1843-1852
- Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings.Ann Surg. 2012; 255: 405-414
- Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): what is gained and what is lost?.Ann Surg. 2012; 256 (author reply e16-9): e9
- ALPPS for patients with colorectal liver metastases: effective liver hypertrophy, but early tumor recurrence.World J Surg. 2014; 38: 1504-1509
- Analysis of the efficacy of portal vein embolization for patients with extensive liver malignancy and very low future liver remnant volume, including a comparison with the associating liver partition with portal vein ligation for staged hepatectomy approach.J Am Coll Surg. 2013; 217 (discussion 33-4): 126-133
- Our initial experience with ALPPS technique: encouraging results.Updates Surg. 2012; 64: 167-172
- Radiofrequency ablation combined with systemic treatment versus systemic treatment alone in patients with non-resectable colorectal liver metastases: a randomized EORTC Intergroup phase II study (EORTC 40004).Ann Oncol. 2012; 23: 2619-2626
- Radiofrequency ablation (RFA) combined with chemotherapy for unresectable colorectal liver metastases (CRC LM): long-term survival results of a randomized phase II study of the EORTC-NCRI CCSG-ALM Intergroup 40004 (CLOCC).J Clin Oncol. 2015; (suppl; abstr 3501): 33
- SIRFLOX: Randomized phase III trial comparing first-line mFOLFOX6 (plus or minus bevacizumab) versus mFOLFOX6 (plus or minus bevacizumab) plus selective internal radiation therapy in patients with metastatic colorectal cancer.J Clin Oncol. 2016; 34: 1723-1731
- Early survival and safety of ALPPS: first report of the International ALPPS Registry.Ann Surg. 2014; 260 (discussion 36-8): 829-836
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Chemotherapy, bevacizumab, and cetuximab in metastatic colorectal cancer.N Engl J Med. 2009; 360: 563-572
- Sequential versus combination chemotherapy with capecitabine, irinotecan, and oxaliplatin in advanced colorectal cancer (CAIRO): a phase III randomised controlled trial.Lancet. 2007; 370: 135-142
- An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav Res. 2011; 46: 399-424
- Patients with initially unresectable colorectal liver metastases: is there a possibility of cure?.J Clin Oncol. 2009; 27: 1829-1835
- A systematic review of two-stage hepatectomy in patients with initially unresectable colorectal liver metastases.HPB (Oxford). 2013; 15: 483-491
- Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases.Ann Surg. 2008; 248: 994-1005
- Strategies to increase the resectability of patients with colorectal liver metastases: a multicenter case-match analysis of ALPPS and conventional two-stage hepatectomy.Ann Surg Oncol. 2015; 22: 1933-1942
- ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis.World J Surg. 2014; 38: 1510-1519
- Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial.Lancet Oncol. 2010; 11: 38-47
- Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients.Ann Surg. 2009; 250: 440-448
- Recurrence following hepatectomy for metastatic colorectal cancer: development of a model that predicts patterns of recurrence and survival.Ann Surg Oncol. 2012; 19: 139-144
- Validation of prognostic scoring systems for patients undergoing resection of colorectal cancer liver metastases.Ann Surg Oncol. 2009; 16: 3279-3288
- Portal vein embolization before liver resection: a systematic review.Cardiovasc Intervent Radiol. 2013; 36: 25-34
- Monosegment ALPPS: A new variant of the techniques for rapid hepatic regeneration. Critical review of the initial results of our series.Cir Esp. 2015; 93: 436-443
- Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy.Surgery. 2015; 157: 676-689
Article info
Publication history
Published online: December 27, 2016
Accepted:
October 19,
2016
Footnotes
The authors declare that there were no conflicts of interest.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
