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ALPPS Improves Rese...
ALPPS Improves Resectability Compared with Conventional Two-stage Hepatectomy in Patients with Advanced Colorectal Liver Metastasis : Results from a Scandinavian Multicenter Randomized Controlled Trial (LIGRO Trial)
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- Sandström, Per (författare)
- Linköpings universitet,Linköping University,Avdelningen för Kirurgi, Ortopedi och Onkologi,Medicinska fakulteten,Region Östergötland, Kirurgiska kliniken US
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- Røsok, Bard I. (författare)
- Oslo university hospital,Oslo Univ Hosp, Norway
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- Sparrelid, Ernesto (författare)
- Karolinska Institutet,Karolinska Institute,Karolinska University Hospital,Karolinska Inst, Sweden
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- Larsen, Peter N. (författare)
- University of Copenhagen,Copenhagen University Hospital,Univ Copenhagen, Denmark
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- Lindhoff Larsson, Anna (författare)
- Linköpings universitet,Linköping University,Avdelningen för Kirurgi, Ortopedi och Onkologi,Medicinska fakulteten,Region Östergötland, Kirurgiska kliniken US
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- Lindell, Gert (författare)
- Lund University,Lunds universitet,Lever-, pankreas- och gallvägskirurgi,Forskargrupper vid Lunds universitet,Hepato-Pancreato-Biliary Surgery,Lund University Research Groups,Skåne University Hospital,Lund Univ, Sweden
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- Schultz, Nicolai A. (författare)
- University of Copenhagen,Copenhagen University Hospital,Univ Copenhagen, Denmark
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- Bjørnbeth, Bjorn A. (författare)
- Oslo university hospital,Oslo Univ Hosp, Norway
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- Isaksson, Bengt (författare)
- Karolinska Institute,Karolinska University Hospital,Karolinska Inst, Sweden
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- Rizell, Magnus (författare)
- University of Gothenburg,Univ Gothenburg, Sweden
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- Björnsson, Bergthor (författare)
- Linköpings universitet,Linköping University,Avdelningen för Kirurgi, Ortopedi och Onkologi,Medicinska fakulteten,Region Östergötland, Kirurgiska kliniken US
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(creator_code:org_t)
- LIPPINCOTT WILLIAMS & WILKINS, 2018
- 2018
- Engelska 8 s.
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Ingår i: Annals of Surgery. - : LIPPINCOTT WILLIAMS & WILKINS. - 0003-4932 .- 1528-1140. ; 267:5, s. 833-840
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https://lup.lub.lu.s...
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Abstract
Ämnesord
Stäng
- Objective: The aim of the study was to evaluate if associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) could increase resection rates (RRs) compared with two-stage hepatectomy (TSH) in a randomized controlled trial (RCT). Background: Radical liver metastasis resection offers the only chance of a cure for patients with metastatic colorectal cancer. Patients with colorectal liver metastasis (CRLM) and an insufficient future liver remnant (FLR) volume are traditionally treated with chemotherapy with portal vein embolization or ligation followed by hepatectomy (TSH). This treatment sometimes fails due to insufficient liver growth or tumor progression. Methods: A prospective, multicenter RCT was conducted between June 2014 and August 2016. It included 97 patients with CRLM and a standardized FLR (sFLR) of less than 30%. Primary outcome - RRs were measured as the percentages of patients completing both stages of the treatment. Secondary outcomes were complications, radicality, and 90-day mortality measured from the final intervention. Results: Baseline characteristics, besides body mass index, did not differ between the groups. The RR was 92% [95% confidence interval (CI) 84%-100%] (44/48) in the ALPPS arm compared with 57% (95% CI 43%-72%) (28/49) in the TSH arm [rate ratio 8.25 (95% CI 2.6-26.6); P < 0.0001]. No differences in complications (Clavien-Dindo ≥3a) [43% (19/44) vs 43% (12/28)] [1.01 (95% CI 0.4-2.6); P = 0.99], 90-day mortality [8.3% (4/48) vs 6.1% (3/49)] [1.39 [95% CI 0.3-6.6]; P = 0.68] or R0 RRs [77% (34/44) vs 57% (16/28)] [2.55 [95% CI 0.9-7.1]; P = 0.11)] were observed. Of the patients in the TSH arm that failed to reach an sFLR of 30%, 12 were successfully treated with ALPPS. Conclusion: ALPPS is superior to TSH in terms of RR, with comparable surgical margins, complications, and short-term mortality.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Nyckelord
- associating liver partition and portal vein ligation for staged hepatectomy
- colorectal liver metastasis
- portal embolization
- portal ligation
- RCT
- two-stage hepatectomy
- associating liver partition and portal vein ligation for staged; hepatectomy; colorectal liver metastasis; portal embolization; portal ligation; RCT; two-stage hepatectomy
Publikations- och innehållstyp
- art (ämneskategori)
- ref (ämneskategori)
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Till lärosätets databas
- Av författaren/redakt...
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Sandström, Per
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Røsok, Bard I.
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Sparrelid, Ernes ...
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Larsen, Peter N.
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Lindhoff Larsson ...
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Lindell, Gert
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Schultz, Nicolai ...
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Bjørnbeth, Bjorn ...
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Isaksson, Bengt
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Rizell, Magnus
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Björnsson, Bergt ...
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- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Kirurgi
- Artiklar i publikationen
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Annals of Surger ...
- Av lärosätet
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Lunds universitet
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Karolinska Institutet
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Linköpings universitet