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Risk Adjustment in ALPPS Is Associated With a Dramatic Decrease in Early Mortality and Morbidity
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- Linecker, Michael (författare)
- University Hospital Zurich, Switzerland
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- Björnsson, Bergthor (författare)
- Linköpings universitet,Avdelningen för Kirurgi, Ortopedi och Onkologi,Medicinska fakulteten,Region Östergötland, Kirurgiska kliniken US
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- Stavrou, Gregor A. (författare)
- Asklepios Hospital Barmbek, Germany; Semmelweis University of Budapest, Germany
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- Oldhafer, Karl J. (författare)
- Asklepios Hospital Barmbek, Germany; Semmelweis University of Budapest, Germany
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- Lurje, Georg (författare)
- University Hospital Aachen, Germany
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- Neumann, Ulf (författare)
- University Hospital Aachen, Germany
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- Adam, Rene (författare)
- Hop Paul Brousse, France
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- Pruvot, Francois-Rene (författare)
- University Hospital, France
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- Topp, Stefan A. (författare)
- University Hospital Dusseldorf, Germany
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- Li, Jun (författare)
- University of Medical Centre Hamburg Eppendorf, Germany
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- Capobianco, Ivan (författare)
- University of Tubingen Hospital, Germany
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- Nadalin, Silvio (författare)
- University of Tubingen Hospital, Germany
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- Autran Machado, Marcel (författare)
- University of Sao Paulo, Brazil
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- Voskanyan, Sergey (författare)
- FMBA, Russia
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- Balci, Deniz (författare)
- Ankara University, Turkey
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- Hernandez-Alejandro, Roberto (författare)
- London Health Science Centre, Canada; University of Rochester, NY 14627 USA
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- Alvarez, Fernando A. (författare)
- Italian Hospital Buenos Aires, Argentina
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- De Santibanes, Eduardo (författare)
- Italian Hospital Buenos Aires, Argentina
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- Robles-Campos, Ricardo (författare)
- Virgen Arrixaca Clin, Spain; University Hospital, Spain
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- Malago, Massimo (författare)
- UCL, England
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- de Oliveira, Michelle L. (författare)
- University Hospital Zurich, Switzerland
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- Lesurtel, Mickael (författare)
- University Hospital Zurich, Switzerland
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- Clavien, Pierre-Alain (författare)
- University Hospital Zurich, Switzerland
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- Petrowsky, Henrik (författare)
- University Hospital Zurich, Switzerland
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(creator_code:org_t)
- LIPPINCOTT WILLIAMS & WILKINS, 2017
- 2017
- Engelska.
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Ingår i: Annals of Surgery. - : LIPPINCOTT WILLIAMS & WILKINS. - 0003-4932 .- 1528-1140. ; 266:5, s. 779-786
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- Objective: To longitudinally assess whether risk adjustment in Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) occurred over time and is associated with postoperative outcome. Background: ALPPS is a novel 2-stage hepatectomy enabling resection of extensive hepatic tumors. ALPPS has been criticized for its high mortality, which is reported beyond accepted standards in liver surgery. Therefore, adjustments in patient selection and technique have been performed but have not yet been studied over time in relation to outcome. Methods: ALPPS centers of the International ALPPS Registry having performed amp;gt;= 10 cases over a period of amp;gt;= 3 years were assessed for 90-day mortality and major interstage complications (amp;gt;= 3b) of the longitudinal study period from 2009 to 2015. The predicted prestage 1 and 2 mortality risks were calculated for each patient. In addition, questionnaires were sent to all centers exploring center-specific risk adjustment strategies. Results: Among 437 patients from 16 centers, a shift in indications toward colorectal liver metastases from 53% to 77% and a reverse trend in biliary tumors from 24% to 9% were observed. Over time, 90-day mortality decreased from initially 17% to 4% in 2015 (P = 0.002). Similarly, major interstage complications decreased from 10% to 3% (P = 0.011). The reduction of 90-day mortality was independently associated with a risk adjustment in patient selection (P amp;lt; 0.001; OR: 1.62; 95% CI: 1.36-1.93) and using less invasive techniques in stage-1 surgery (P = 0.019; OR: 0.39; 95% CI: 0.18-0.86). A survey indicated risk adjustment of patient selection in all centers and ALPPS technique in the majority (80%) of centers. Conclusions: Risk adjustment of patient selection and technique in ALPPS resulted in a continuous drop of early mortality and major postoperative morbidity, which has meanwhile reached standard outcome measures accepted for major liver surgery.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Nyckelord
- ALPPS; colorectal liver metastases; less invasive ALPPS variants; outcome; risk adjustment; two-stage hepatectomy
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Linecker, Michae ...
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Björnsson, Bergt ...
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Stavrou, Gregor ...
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Oldhafer, Karl J ...
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Lurje, Georg
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Neumann, Ulf
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Adam, Rene
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Pruvot, Francois ...
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Topp, Stefan A.
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Li, Jun
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Capobianco, Ivan
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Nadalin, Silvio
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Autran Machado, ...
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Voskanyan, Serge ...
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Balci, Deniz
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Hernandez-Alejan ...
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Alvarez, Fernand ...
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De Santibanes, E ...
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Robles-Campos, R ...
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Malago, Massimo
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de Oliveira, Mic ...
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Lesurtel, Mickae ...
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Clavien, Pierre- ...
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Petrowsky, Henri ...
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- MEDICIN OCH HÄLSOVETENSKAP
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och Klinisk medicin
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och Kirurgi
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Annals of Surger ...
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Linköpings universitet