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Patient Survival After Simultaneous ALPPS and Colorectal Resection

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Abstract

Background

Liver resection combined with colorectal surgery (CRS) is the only curative option in many patients presenting with synchronous colorectal cancer and liver metastases (CRLM). Simultaneous resection has been shown to offer benefits in patients with low hepatic tumor load; however, in the setting of in situ colorectal tumor with extensive CRLM and a small predicted future liver remnant (FLR), the use of simultaneous ALPPS and CRS is controversial, lacking outcome data.

Methods

Thirty-one cases of simultaneous ALPPS and CRS prospectively entered into the International ALPPS Registry were examined. Univariate analysis was used to identify factors associated with 90-day mortality after stage-2.

Results

Thirty patients (97%) completed both stages. CRS was performed during stage-1 in 22 patients (73%). Seven patients (23%) had severe complications (Clavien-Dindo ≥ IIIb) following stage-2 ALPPS. The 90-day mortality rate was 15%. Patients who had a severe complication after stage-1 were significantly more likely to have 90-day mortality following stage-2 (p = 0.002). MELD score > 10 on postoperative day-5 after stage-1 was also significantly associated with 90-day mortality (p = 0.011). Disease-free survival and overall survival were 36% and 76% at 1 year, respectively.

Conclusions

In light of the high mortality and poor long-term survival identified in this series, the adoption of ALPPS with CRS cannot be recommended without further data. Patients who suffer severe complications or have an elevated MELD score after stage-1 are at higher risk of mortality following stage-2.

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Acknowledgements

We would like to thank Sayra Cristancho and the Center for Education Research and Innovation (CERI) at Western University for their expertise and support in the process of writing this study for publication. We are grateful to the administrators and contributors of the International ALPPS Registry for providing the data. We also thank Dr. Kelly Vogt from the Department of Surgery at London Health Sciences Center for her support in the design and statistical analysis of our study.

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Authors and Affiliations

  1. Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

    Kerollos Nashat Wanis, Suzana Buac & Mauro Enrique Tun-Abraham

  2. Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland

    Michael Linecker & Pierre-Alain Clavien

  3. Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina

    Victoria Ardiles & Eduardo de Santibañes

  4. Multi-Organ Transplant Program, London Health Sciences Center, London, ON, Canada

    Mauro Enrique Tun-Abraham

  5. Department of General Surgery, Liver Transplant Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain

    Ricardo Robles-Campos

  6. Department of HPB and Liver Transplant Surgery, Royal Free Hospital, University College London, London, UK

    Massimo Malago

  7. Division of Hepatobiliary Surgery and Transplantation, Department of Surgery, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA

    Roberto Hernandez-Alejandro

Authors
  1. Kerollos Nashat Wanis
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  2. Suzana Buac
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  3. Michael Linecker
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  4. Victoria Ardiles
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  5. Mauro Enrique Tun-Abraham
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  6. Ricardo Robles-Campos
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  7. Massimo Malago
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  8. Eduardo de Santibañes
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  9. Pierre-Alain Clavien
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  10. Roberto Hernandez-Alejandro
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Corresponding author

Correspondence to Roberto Hernandez-Alejandro.

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Wanis, K.N., Buac, S., Linecker, M. et al. Patient Survival After Simultaneous ALPPS and Colorectal Resection. World J Surg 41, 1119–1125 (2017). https://doi.org/10.1007/s00268-016-3818-1

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  • DOI: https://doi.org/10.1007/s00268-016-3818-1

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