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Impact of Chemotherapy on Kinetic Growh and Outcomes in ALPPS

Bergthor Björnsson
Department / Institution: 
US Linkoping, Sweden
Date Project Approved: 
Tuesday, 20 May, 2014
Project Status: 
Application / Abstract: 
The key importance of ALPPS is to induce rapid growth of the FLR to enable a safe R0 resection in the second step. Oncological treatment may be the only primary option to reach the possibility of ALPPS. If the combination of oncological treatment in itself reduces the ability for the liver to grow it is counterproductive and a different oncological treatment might have been a better choice. The knowledge of different combinations of chemotherapy and monoclonal antibodies effect on FLR growth in the ALPPS setting is unknown. The hypothesis is that oncological treatment reduces liver growth and increases postoperative complications. Longer preoperative treatment aggravates this further. Addition of antibodies may further impair the liver growth. This information may help us choosing the best combination or refrain from preoperative treatment whenever possible to increase resection rate.
Study design: A retrospective analysis of all patients registered in the ALPPS register as treated for CRLM. Study questions: 1) Absolute growth of FLR as well as relative growth and KGR in patients treated with chemotherapy as compared to those not treated. (Chemotherapy+/-ab vs no no preoperative chemotherapy). 2) The same variables in patients treated with anti-angiogenetic drugs as compared to those treated with chemotherapy alone (Chemotherapy-ab vs chemotherapy+ab). 3) The same variables in patients treated with different anti-angiogenetic drugs (ab) (Chemotherapy+ab(Erbitux) vs.Chemotherapy+ab(avastin)). 4) Does chemotherapy (+/- ab) increase the risk for post operative complications. Data on chemotherapy: Length of therapy, number of cycles, what regimen, time between chemotherapy and operation 1. Possible confounders/co-variables to be included: Age, sex, ASA. Size of FLR before ALPPS, type of ALPPS (number of segments in FLR, what side) Co-morbidity (IHD, HTN, DM, renal function, liver disese MI, CHF, peripheral vascular disease, ceribrovascular,COPD, PUD, Liver disease, CRF, HIV, TB, DM. Earlier liver resections. Drug use: aspirin, plavix, coumidin, digoxin, HTN Rx, diuretica, antianginal, steroids (resp), acid blockade (GI). Operative data operation 1 (time, bleeding, Pringle)


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