ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2019
Two-Stage Hepatectomy and ALPPS for Advanced Bilateral Liver Metastases: a Tailored Approach Balancing Risk and Outcome.
Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 4 of them syntheses that pooled it.
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Who cites it
16 citing papers in PubMed, 4 syntheses or guidelines pooled it, 38 citations in OpenAlex.
- Pooled it
- Efficacy and safety of different options for liver regeneration of future liver remnant in patients with liver malignancies: a systematic review and network meta-analysis.World journal of surgical oncology · 2022Pooled it
- [Evidence of minimally invasive oncological surgery of the liver].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2021Pooled it
- Conventional Two-Stage Hepatectomy or Associating Liver Partitioning and Portal Vein Ligation for Staged Hepatectomy for Colorectal Liver Metastases? A Systematic Review and Meta-Analysis.Frontiers in oncology · 2020Pooled it
- Laparoscopic versus open right hepatectomy for colorectal liver metastases after portal vein embolization: international multicentre study.The British journal of surgery · 2024Article
- Adjuvant chemotherapy is associated with better oncological outcomes after ALPPS for colorectal liver metastases.Updates in surgery · 2024Observational
- Article
- Two-stage hepatectomy in resection of colorectal liver metastases - a single-institution experience with case-control matching and review of the literature.Radiology and oncology · 2023Review
- Hepatectomy with Perioperative Chemotherapy for Multiple Colorectal Liver Metastases is the Available Option for Prolonged Survival.Annals of surgical oncology · 2022Article
- Patient-centered developments in colon- and rectal cancer with a multidisciplinary international team: From translational research to national guidelines.World journal of gastrointestinal surgery · 2021Review
- Systematic extended posterior right sectionectomy with simultaneous resection of the dorsal part of segment 1 and middle hepatic vein detachment.Clinical case reports · 2021Article
- Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Registry: What Have We Learned?Gut and liver · 2020Review
- Integrative Concepts for Liver Surgery.Visceral medicine · 2020Review
- Liver resection is beneficial for patients with colorectal liver metastases and extrahepatic disease.Annals of translational medicine · 2020Article
- ALPPS versus two-stage hepatectomy for colorectal liver metastases--a comparative retrospective cohort study.World journal of surgical oncology · 2020Article
- Long-Term Outcome After Conventional Two-Stage Hepatectomy Versus Tourniquet-ALPPS in Colorectal Liver Metastases: A Propensity Score Matching Analysis.World journal of surgery · 2019Article
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimTwo-stage hepatectomy (TSH) with or without portal vein ligation (PVL) or portal vein embolization (PVE) and associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) are surgical strategies in the treatment of advanced colorectal liver metastases (CRLM). The role of each strategy is yet ill defined. The aim of this analysis is to share our center experience with conventional TSH with or without PVL/PVE and ALPPS in patients with advanced bilateral CRLM. PATIENTS AND
methodsData were extracted from a prospectively collected institutional database. Complication rates according to the Dindo-Clavien classification, overall and recurrence-free survival data were analyzed.
resultsBetween 2008 and 2017, 790 liver resections were performed in 611 patients with CRLM. Out of 320 patients with bilateral disease, TSH (as right or extended right hepatectomy) with or without PVL/PVE was performed in 50 patients and ALPPS in 8. Stage 2 was completed in 36 (72%) out of 50 TSH/PVL/PVE and in all ALPPS patients (100%). Median follow-up was 15.8 months (0.9 to 111.9 months). On an intention-to-treat basis, the median overall survival was 26.7 (21.8-35.1 range) months after TSH/PVL/PVE and 36.2 months (11.3-61.2 range) after ALPPS (p = 0.809). In the TSH/PVL/PVE cohort, the median overall survival was 29.9 (19.0-40.3) months in patients who completed stage 2 compared to 13.8 months in patients who did not (p < 0.001). Disease recurred in 60% in the TSH/PVL/PVE cohort and in 87.5% in the ALPPS cohort (p = 0.777). The median recurrence-free survival was 5.9 (1.7-18.6) months after TSH/PVL/PVE and 3 (1.6-14.8) months after ALPPS (p = 0.680).
conclusionThe treatment of advanced bilateral CRLM remains a surgical and oncological challenge. A tailored approach to bilateral CRLM uses TSH/PVL/PVE as first and ALPPS as second rescue treatment in order to achieve resectability in patients with extensive tumor burden not amenable to one-stage resection. ALPPS should be reserved for patients with no other surgical options.
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