Evidence map›Paper›PMID 40778636›Full record

ArticleAnnals of surgery2026

Liver Transplantation Versus ALPPS for Colorectal Liver Metastases: An Entropy Balanced Retrospective Analysis.

Matteo Serenari, Jacopo Lanari, Svein Dueland, Giuseppe Maria Ettorre, Luca Aldrighetti, Marco Vivarelli, Fabrizio Di Benedetto, Domenico Pinelli, Vincenzo Mazzaferro, Marco Massani and 7 more

Abstract readComparative StudyMulticenter Study
PubMed Publisher
In one paragraph

Article in Annals of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
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

4 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors.

Matteo SerenariHepato-biliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Jacopo LanariDepartment of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
Svein DuelandDepartment of Transplantation Medicine, Transplant Oncology Research Group, Oslo University Hospital, Oslo, Norway.
Giuseppe Maria EttorreDivision of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy.
Luca AldrighettiIRCCS San Raffaele Scientific Institute, Milan, Italy.
Marco VivarelliDepartment of Clinical and Experimental Medicine, HPB Surgery and Transplantation Unit, Polytechnic University of Marche, Ancona, Italy.
Fabrizio Di BenedettoHepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
Domenico PinelliChirurgia 3-Centro Trapianti, ASST Papa Giovanni XXIII-Bergamo, Italy.
Vincenzo MazzaferroDepartment of Surgery, Division of HPB, General Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy.
Marco MassaniRegional Center for HPB Surgery, Regional Hospital of Treviso, Treviso, Italy.
Alessandro FerreroDepartment of General and Oncological Surgery, Mauriziano Hospital "Umberto I", Turin, Italy.
Gian Luca GraziDepartment of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
Umberto CilloDepartment of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
Elio JovineDepartment of Medical and Surgical Sciences, General Surgery and Transplantation Unit, University of Bologna, Italy.
Matteo CesconHepato-biliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Pal Dag LineDepartment of Transplantation Medicine, Transplant Oncology Research Group, Oslo University Hospital, Oslo, Norway.
ALPPS Italian Registry

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe primary endpoint of this study was to compare liver transplantation (LT) with Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) in the treatment of colorectal liver metastases (CRLM).

backgroundALPPS is usually performed for borderline CRLM cases and published oncological outcomes appear to be inferior to those obtained after LT.

methodsAll consecutive patients undergoing ALPPS for CRLM across 14 centers between September 2012 and September 2022 were considered. The selected ALPPS patients were compared with patients receiving LT from November 2006 to June 2019 performed at a single institution. Entropy balancing was applied to eliminate all confounding bias simulating what would have happened if ALPPS patients had been transplanted.

resultsDuring the study period, 121 consecutive patients were submitted to ALPPS and 46 were enrolled by fulfilling the inclusion criteria. These 46 cases were compared with 54 patients submitted to LT. Median OS after ALPPS was 76 months (95% CI: 28.9-123) compared with 72.7 months in patients who underwent LT (95% CI: 43.4-102 months). After reweighting, the risk of death related to ALPPS was higher when compared with LT (HR=1.40, 95% CI: 0.63-3.09) but no significant differences were found between the 2 groups ( P =0.398). When splitting the ALPPS cohort into completed and failed procedures, the median OS in failed ALPPS (31.1 months, 95% CI: 0-73.3 months) was significantly lower than that of patients submitted to LT ( P =0.043). When ALPPS patients were further selected based on SECA-II criteria, the median OS was significantly ( P =0.022) higher in the LT group (not reached) compared with ALPPS (76 months, 95% CI: 21-130 months).

conclusionsLT without current stringent selection criteria did not provide a significant survival benefit compared with ALPPS. The final choice between these 2 strategies seems to depend on the possibility of completing stage 2 and whether the patient meets the most updated transplant criteria.

Indexed as

Colorectal NeoplasmsHepatectomyLiver NeoplasmsLiver TransplantationPortal VeinAgedEntropyFemaleHumansLigationMaleMiddle AgedRetrospective StudiesTreatment OutcomeAssociating Liver Partition and Portal Vein Ligation for Staged Hepatectomycolorectal cancerliver metastasesliver transplantation

Identifiers

PMID40778636

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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.