Evidence map›Paper›PMID 28902669›Full record

Trial reportAnnals of surgery2018

ALPPS Improves Resectability Compared With Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastasis: Results From a Scandinavian Multicenter Randomized Controlled Trial (LIGRO Trial).

Per Sandström, Bård I Røsok, Ernesto Sparrelid, Peter N Larsen, Anna L Larsson, Gert Lindell, Nicolai A Schultz, Bjorn A Bjørnbeth, Bengt Isaksson, Magnus Rizell and 1 more

Open access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 149 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
149citing papers in PubMed, 8 pooled it
17.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

149 citing papers in PubMed, 8 syntheses or guidelines pooled it, 328 citations in OpenAlex.

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  11. Article
  12. Changing concepts in perihilar cholangiocarcinoma resections and surgery.International journal of surgery (London, England) · 2026
    Article
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  20. Time as a Therapeutic Ally: The Promise of Long-Term Solid Organ and Tissue Perfusion.Transplant international : official journal of the European Society for Organ Transplantation · 2026
    Review

89 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 3 countries.

Per SandströmDepartment of Surgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Bård I RøsokDepartment of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.
Ernesto SparrelidDepartment of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Peter N LarsenDepartment of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Denmark.
Anna L LarssonDepartment of Surgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Gert LindellLund University, Department of Surgery, Skane University Hospital, Lund, Sweden.
Nicolai A SchultzDepartment of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Denmark.
Bjorn A BjørnbethDepartment of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.
Bengt IsakssonDepartment of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Magnus RizellDepartment of Transplantation and Liver Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Bergthor BjörnssonDepartment of Surgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Linköping University · SEKarolinska University Hospital · SEOslo University Hospital · NORigshospitalet · DKLund University · SEUniversity of Gothenburg · SE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe aim of the study was to evaluate if associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) could increase resection rates (RRs) compared with two-stage hepatectomy (TSH) in a randomized controlled trial (RCT).

backgroundRadical liver metastasis resection offers the only chance of a cure for patients with metastatic colorectal cancer. Patients with colorectal liver metastasis (CRLM) and an insufficient future liver remnant (FLR) volume are traditionally treated with chemotherapy with portal vein embolization or ligation followed by hepatectomy (TSH). This treatment sometimes fails due to insufficient liver growth or tumor progression.

methodsA prospective, multicenter RCT was conducted between June 2014 and August 2016. It included 97 patients with CRLM and a standardized FLR (sFLR) of less than 30%. Primary outcome-RRs were measured as the percentages of patients completing both stages of the treatment. Secondary outcomes were complications, radicality, and 90-day mortality measured from the final intervention.

resultsBaseline characteristics, besides body mass index, did not differ between the groups. The RR was 92% [95% confidence interval (CI) 84%-100%] (44/48) in the ALPPS arm compared with 57% (95% CI 43%-72%) (28/49) in the TSH arm [rate ratio 8.25 (95% CI 2.6-26.6); P < 0.0001]. No differences in complications (Clavien-Dindo ≥3a) [43% (19/44) vs 43% (12/28)] [1.01 (95% CI 0.4-2.6); P = 0.99], 90-day mortality [8.3% (4/48) vs 6.1% (3/49)] [1.39 [95% CI 0.3-6.6]; P = 0.68] or R0 RRs [77% (34/44) vs 57% (16/28)] [2.55 [95% CI 0.9-7.1]; P = 0.11)] were observed. Of the patients in the TSH arm that failed to reach an sFLR of 30%, 12 were successfully treated with ALPPS.

conclusionALPPS is superior to TSH in terms of RR, with comparable surgical margins, complications, and short-term mortality.

Indexed as

Margins of ExcisionNeoplasm StagingAgedColorectal NeoplasmsFemaleFollow-Up StudiesHepatectomyHumansLigationLiver NeoplasmsMaleMiddle AgedPrognosisProspective StudiesScandinavian and Nordic CountriesSurvival Rate

Identifiers

PMID28902669
PMCPMC5916470
OpenAlexW2756240370

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.