Early Survival and Safety of ALPPS First Report of the International ALPPS Registry

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art_SCHADDE_Early_Survival_and_Safety_of_ALPPS_First_Report_2014.PDF (385.03 KB)
Citações na Scopus
382
Tipo de produção
article
Data de publicação
2014
Editora
LIPPINCOTT WILLIAMS & WILKINS
DOI
Indexadores
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Autores
SCHADDE, Erik
ARDILES, Victoria
ROBLES-CAMPOS, Ricardo
MALAGO, Massimo
HERNANDEZ-ALEJANDRO, Roberto
SOUBRANE, Olivier
SCHNITZBAUER, Andreas A.
RAPTIS, Dimitri
TSCHUOR, Christoph
Autor de Grupo de pesquisa
ALPPS Registry Grp
Editores
Coordenadores
Organizadores
Citação
ANNALS OF SURGERY, v.260, n.5, p.829-838, 2014
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Objectives: To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry. Background: ALPPS induces accelerated growth of small future liver remnants (FLR) to allow curative resection of liver tumors. There is concern about safety based on reports of higher morbidity and mortality. Methods: A Web-based data entry system was created with password access and data pseudoencryption (NCT01924741). All patients with complete 90-day data were included. Multivariate logistic regression analysis was performed to identify independent risk factors for severe complications and mortality and volume growth of the FLR. Results: Complete data were available for 202 patients. A total of 141 (70%) patients had colorectal liver metastases (CRLM). Median starting standardized future liver remnants of 21% increased by 80% within a median of 7 days. Ninety-day mortality was 19/202 (9%). Severe complications including mortalities (Clavien-Dindo >= IIIb) occurred in 27% of patients. Independent factors for severe complications were red blood cell transfusion [odds ratio (OR), 5.2), ALPPS stage I operating time greater than 300 minutes (OR, 4.4), age more than 60 years (OR, 3.8), and non-CRLM (OR, 2.7). Age, use of Pringle maneuver, and histologic changes led to less volume growth. In patients younger than 60 years with CRLM, 90-day mortality was similar to conventional 2-stage hepatectomies for CRLM. Conclusions: This is the first analysis of the ALPPS registry showing that ALPPS has increased perioperative morbidity and mortality in older patients but better outcomes in patients with CRLM.
Palavras-chave
ALPPS, hepatectomy, hypertrophy, liver tumors, portal vein (qualifier surgery)
URI
https://observatorio.fm.usp.br/handle/OPI/16367
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Coleções
Artigos e Materiais de Revistas Científicas - FM/Outros
Artigos e Materiais de Revistas Científicas - ODS/03