ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION (ALPPS) FOR COLORECTAL LIVER METASTASIS: REVIEW & SINGLE-CENTER STUDY
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.34635/rpc.926 |
Resumo: | The associating liver partitioning and portal vein ligation for staged hepatectomy has gained interest in the treatment of unresectable colorectal liver metastases as it has allowed to expand the limits of oncological resectability. Despite the initial poor outcomes associated to this procedure, recent reports have showed reduced morbimortality in well selected patients. The current study evaluates the outcomes of ALPPS procedure in treatment of colorectal liver metastasis at our department and identify morbimortality and survival prognostic factors. A retrospective cohort study was performed, all consecutive patients submitted to ALPPS procedure between 2015 and 2020 were included. Twenty-one patients with 61,8±10,8 (37-78), 76,2% were male, with 12,05±6,34 (5-30) hepatic nodules, whose largest size was 42.3 ± 17, 5 (18-75) mm. Among these, 71.4% underwent induction chemotherapy with FOLFIRI and 61,9% with plus Cetuximab, mean of 10,9±5,6 (4-24) cycles. At ALPPS stage 1, 6±4 (1-18) nodules were resected, 19% with concomitant splenic artery occlusion and a mean Pringle Maneuver of 33±26 (0-94) minutes. All patients did adjuvant CT. We report a global mortality of 9,6% and a major morbidity (MMb) of 28,6%. The multivariable analysis identified as risk factor for MMb: more than 10 nodules, size>38mm, interstage interval> 14 days and the resection of more than 4 lesions at stage 1. The overall survival and disease-free survival rates were 25,9± 4,2 (17,6- 34,1), 17,64 ±3,95 (9,9-25,4) moths, respectively. Age >56 years and size >38mm were identified as risk factor for poor outcome. More than 10 cycles of neoadjuvant chemotherapy were identified as risk factor for poor outcome at 2 years. Our results are similar to the recently established reference values. |
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ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION (ALPPS) FOR COLORECTAL LIVER METASTASIS: REVIEW & SINGLE-CENTER STUDYASSOCIAÇÃO DA PARTIÇÃO HEPÁTICA À LAQUEAÇÃO DA VEIA PORTA NO TRATAMENTO DE METÁSTASES HEPÁTICAS POR CANCRO COLORECTAL: REVISÃO DO TEMA E RESULTADOS DE UM CENTROThe associating liver partitioning and portal vein ligation for staged hepatectomy has gained interest in the treatment of unresectable colorectal liver metastases as it has allowed to expand the limits of oncological resectability. Despite the initial poor outcomes associated to this procedure, recent reports have showed reduced morbimortality in well selected patients. The current study evaluates the outcomes of ALPPS procedure in treatment of colorectal liver metastasis at our department and identify morbimortality and survival prognostic factors. A retrospective cohort study was performed, all consecutive patients submitted to ALPPS procedure between 2015 and 2020 were included. Twenty-one patients with 61,8±10,8 (37-78), 76,2% were male, with 12,05±6,34 (5-30) hepatic nodules, whose largest size was 42.3 ± 17, 5 (18-75) mm. Among these, 71.4% underwent induction chemotherapy with FOLFIRI and 61,9% with plus Cetuximab, mean of 10,9±5,6 (4-24) cycles. At ALPPS stage 1, 6±4 (1-18) nodules were resected, 19% with concomitant splenic artery occlusion and a mean Pringle Maneuver of 33±26 (0-94) minutes. All patients did adjuvant CT. We report a global mortality of 9,6% and a major morbidity (MMb) of 28,6%. The multivariable analysis identified as risk factor for MMb: more than 10 nodules, size>38mm, interstage interval> 14 days and the resection of more than 4 lesions at stage 1. The overall survival and disease-free survival rates were 25,9± 4,2 (17,6- 34,1), 17,64 ±3,95 (9,9-25,4) moths, respectively. Age >56 years and size >38mm were identified as risk factor for poor outcome. More than 10 cycles of neoadjuvant chemotherapy were identified as risk factor for poor outcome at 2 years. Our results are similar to the recently established reference values.The associating liver partitioning and portal vein ligation for staged hepatectomy has gained interest in the treatment of unresectable colorectal liver metastases as it has allowed to expand the limits of oncological resectability. Despite the initial poor outcomes associated to this procedure, recent reports have showed reduced morbimortality in well selected patients. The current study evaluates the outcomes of ALPPS procedure in treatment of colorectal liver metastasis at our department and identify morbimortality and survival prognostic factors. A retrospective cohort study was performed, all consecutive patients submitted to ALPPS procedure between 2015 and 2020 were included. Twenty-one patients with 61,8±10,8 (37-78), 76,2% were male, with 12,05±6,34 (5-30) hepatic nodules, whose largest size was 42.3 ± 17, 5 (18-75) mm. Among these, 71.4% underwent induction chemotherapy with FOLFIRI and 61,9% with plus Cetuximab, mean of 10,9±5,6 (4-24) cycles. At ALPPS stage 1, 6±4 (1-18) nodules were resected, 19% with concomitant splenic artery occlusion and a mean Pringle Maneuver of 33±26 (0-94) minutes. All patients did adjuvant CT. We report a global mortality of 9,6% and a major morbidity (MMb) of 28,6%. The multivariable analysis identified as risk factor for MMb: more than 10 nodules, size>38mm, interstage interval> 14 days and the resection of more than 4 lesions at stage 1. The overall survival and disease-free survival rates were 25,9± 4,2 (17,6- 34,1), 17,64 ±3,95 (9,9-25,4) moths, respectively. Age >56 years and size >38mm were identified as risk factor for poor outcome. More than 10 cycles of neoadjuvant chemotherapy were identified as risk factor for poor outcome at 2 years. Our results are similar to the recently established reference values.Sociedade Portuguesa de Cirurgia2022-12-14info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.34635/rpc.926https://doi.org/10.34635/rpc.926Revista Portuguesa de Cirurgia; No 53 (2022): December 2022; 57-66Revista Portuguesa de Cirurgia; No 53 (2022): December 2022; 57-662183-11651646-6918reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://revista.spcir.com/index.php/spcir/article/view/926https://revista.spcir.com/index.php/spcir/article/view/926/651Copyright (c) 2022 Revista Portuguesa de Cirurgiainfo:eu-repo/semantics/openAccessRuivo, AnaNemésio, RodrigoMartins, RicardoPinho, AntónioTralhão, José Guilherme2024-03-14T22:05:22Zoai:revista.spcir.com:article/926Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T04:00:53.701558Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION (ALPPS) FOR COLORECTAL LIVER METASTASIS: REVIEW & SINGLE-CENTER STUDY ASSOCIAÇÃO DA PARTIÇÃO HEPÁTICA À LAQUEAÇÃO DA VEIA PORTA NO TRATAMENTO DE METÁSTASES HEPÁTICAS POR CANCRO COLORECTAL: REVISÃO DO TEMA E RESULTADOS DE UM CENTRO |
title |
ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION (ALPPS) FOR COLORECTAL LIVER METASTASIS: REVIEW & SINGLE-CENTER STUDY |
spellingShingle |
ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION (ALPPS) FOR COLORECTAL LIVER METASTASIS: REVIEW & SINGLE-CENTER STUDY Ruivo, Ana |
title_short |
ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION (ALPPS) FOR COLORECTAL LIVER METASTASIS: REVIEW & SINGLE-CENTER STUDY |
title_full |
ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION (ALPPS) FOR COLORECTAL LIVER METASTASIS: REVIEW & SINGLE-CENTER STUDY |
title_fullStr |
ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION (ALPPS) FOR COLORECTAL LIVER METASTASIS: REVIEW & SINGLE-CENTER STUDY |
title_full_unstemmed |
ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION (ALPPS) FOR COLORECTAL LIVER METASTASIS: REVIEW & SINGLE-CENTER STUDY |
title_sort |
ASSOCIATING LIVER PARTITION AND PORTAL VEIN LIGATION (ALPPS) FOR COLORECTAL LIVER METASTASIS: REVIEW & SINGLE-CENTER STUDY |
author |
Ruivo, Ana |
author_facet |
Ruivo, Ana Nemésio, Rodrigo Martins, Ricardo Pinho, António Tralhão, José Guilherme |
author_role |
author |
author2 |
Nemésio, Rodrigo Martins, Ricardo Pinho, António Tralhão, José Guilherme |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Ruivo, Ana Nemésio, Rodrigo Martins, Ricardo Pinho, António Tralhão, José Guilherme |
description |
The associating liver partitioning and portal vein ligation for staged hepatectomy has gained interest in the treatment of unresectable colorectal liver metastases as it has allowed to expand the limits of oncological resectability. Despite the initial poor outcomes associated to this procedure, recent reports have showed reduced morbimortality in well selected patients. The current study evaluates the outcomes of ALPPS procedure in treatment of colorectal liver metastasis at our department and identify morbimortality and survival prognostic factors. A retrospective cohort study was performed, all consecutive patients submitted to ALPPS procedure between 2015 and 2020 were included. Twenty-one patients with 61,8±10,8 (37-78), 76,2% were male, with 12,05±6,34 (5-30) hepatic nodules, whose largest size was 42.3 ± 17, 5 (18-75) mm. Among these, 71.4% underwent induction chemotherapy with FOLFIRI and 61,9% with plus Cetuximab, mean of 10,9±5,6 (4-24) cycles. At ALPPS stage 1, 6±4 (1-18) nodules were resected, 19% with concomitant splenic artery occlusion and a mean Pringle Maneuver of 33±26 (0-94) minutes. All patients did adjuvant CT. We report a global mortality of 9,6% and a major morbidity (MMb) of 28,6%. The multivariable analysis identified as risk factor for MMb: more than 10 nodules, size>38mm, interstage interval> 14 days and the resection of more than 4 lesions at stage 1. The overall survival and disease-free survival rates were 25,9± 4,2 (17,6- 34,1), 17,64 ±3,95 (9,9-25,4) moths, respectively. Age >56 years and size >38mm were identified as risk factor for poor outcome. More than 10 cycles of neoadjuvant chemotherapy were identified as risk factor for poor outcome at 2 years. Our results are similar to the recently established reference values. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-12-14 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.34635/rpc.926 https://doi.org/10.34635/rpc.926 |
url |
https://doi.org/10.34635/rpc.926 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://revista.spcir.com/index.php/spcir/article/view/926 https://revista.spcir.com/index.php/spcir/article/view/926/651 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2022 Revista Portuguesa de Cirurgia info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2022 Revista Portuguesa de Cirurgia |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Cirurgia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Cirurgia |
dc.source.none.fl_str_mv |
Revista Portuguesa de Cirurgia; No 53 (2022): December 2022; 57-66 Revista Portuguesa de Cirurgia; No 53 (2022): December 2022; 57-66 2183-1165 1646-6918 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
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1799138183287406592 |