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Is pace the key to success when exploring the ALPPS?

P Kron, M Linecker,GR Nana, P Mueller, D Keane, D Trinca, H Petrowsky, P-A Clavien JPA Lodge
Department / Institution: 
Department of HPB and Transplant, St James’s University Hospital, Beckett Street, LS9 7TF, Leeds, UK; Department of Clinical Engineering, St James’s University Hospital, Beckett Street, LS9 8FT, Leeds, UK; Swiss HPB and Transplant Centre, University Hospital of Zurich, 8091, Zurich, Switzerland
Date Project Approved: 
Tuesday, 4 September, 2018
Project Status: 
Application / Abstract: 
The optimal inter-stage interval for ALPPS has not yet been defined, with most proponents suggesting a rapid second stage within 6 to 10 days as the key to success compared to classical 4-8 weeks for two stage liver resection. However, without accurate volumetric and functional future liver remnant (FLR) assessment, this is a high-risk strategy associated with high morbidity and mortality, which has discouraged uptake of ALPPS in new centres. In this analysis we aimed to investigate the impact of delaying the second stage (inter-stage interval ≥ 14 days, d-ALPPS) in the treatment algorithm of colorectal liver metastases (CRLM) in comparison to ALPPS (inter-stage interval<14 days) to determine if d-ALPPS is a safe option for centres with no access to volumetric and functional FLR analysis.
A prospective multi centric analysis was performed, including consecutive patients ≥ 18 years undergoing ALPPS (inter-stage interval < 14 days, n=19) and d-ALPPS (inter-stage interval ≥ 14 days, n=19) for CRLM between January 2013 and December 2018. The two cohorts were propensity score matched. The primary endpoints focused on onco-surgical outcomes including R0 resection, completion rate and one year survival rates. Secondary endpoints were morbidity and mortality. We used propensity score matching to reduce differences in confounding variables between the groups being compared. Matching variables were age, sex and synchronous/metachronous disease. The cohorts were matched 1:1. Standardised differences were used to assess balance between groups. We compared outcomes using the Z-test for comparing proportions with a p-value of 0.05 being considered statistically significant.


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