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Risk Adjustment in ALPPS Is Associated With a Dramatic Decrease in Early Mortality and Morbidity

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Risk Adjustment in ALPPS Is Associated With a Dramatic Decrease in Early Mortality and Morbidity. / Linecker, Michael; Björnsson, Bergthor; Stavrou, Gregor A; Oldhafer, Karl J; Lurje, Georg; Neumann, Ulf; Adam, René; Pruvot, Francois-René; Topp, Stefan A; Li, Jun; Capobianco, Ivan; Nadalin, Silvio; Machado, Marcel Autran; Voskanyan, Sergey; Balci, Deniz; Hernandez-Alejandro, Roberto; Alvarez, Fernando A; De Santibañes, Eduardo; Robles-Campos, Ricardo; Malagó, Massimo; de Oliveira, Michelle L; Lesurtel, Mickael; Clavien, Pierre-Alain; Petrowsky, Henrik.

In: ANN SURG, Vol. 266, No. 5, 11.2017, p. 779-786.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Linecker, M, Björnsson, B, Stavrou, GA, Oldhafer, KJ, Lurje, G, Neumann, U, Adam, R, Pruvot, F-R, Topp, SA, Li, J, Capobianco, I, Nadalin, S, Machado, MA, Voskanyan, S, Balci, D, Hernandez-Alejandro, R, Alvarez, FA, De Santibañes, E, Robles-Campos, R, Malagó, M, de Oliveira, ML, Lesurtel, M, Clavien, P-A & Petrowsky, H 2017, 'Risk Adjustment in ALPPS Is Associated With a Dramatic Decrease in Early Mortality and Morbidity', ANN SURG, vol. 266, no. 5, pp. 779-786. https://doi.org/10.1097/SLA.0000000000002446

APA

Linecker, M., Björnsson, B., Stavrou, G. A., Oldhafer, K. J., Lurje, G., Neumann, U., Adam, R., Pruvot, F-R., Topp, S. A., Li, J., Capobianco, I., Nadalin, S., Machado, M. A., Voskanyan, S., Balci, D., Hernandez-Alejandro, R., Alvarez, F. A., De Santibañes, E., Robles-Campos, R., ... Petrowsky, H. (2017). Risk Adjustment in ALPPS Is Associated With a Dramatic Decrease in Early Mortality and Morbidity. ANN SURG, 266(5), 779-786. https://doi.org/10.1097/SLA.0000000000002446

Vancouver

Linecker M, Björnsson B, Stavrou GA, Oldhafer KJ, Lurje G, Neumann U et al. Risk Adjustment in ALPPS Is Associated With a Dramatic Decrease in Early Mortality and Morbidity. ANN SURG. 2017 Nov;266(5):779-786. https://doi.org/10.1097/SLA.0000000000002446

Bibtex

@article{b7b7189c709c490dadfc8bf5a5af458c,
title = "Risk Adjustment in ALPPS Is Associated With a Dramatic Decrease in Early Mortality and Morbidity",
abstract = "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 ≥10 cases over a period of ≥3 years were assessed for 90-day mortality and major interstage complications (≥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 < 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.",
keywords = "Aged, Colorectal Neoplasms, Female, Hepatectomy, Humans, Ligation, Liver Neoplasms, Logistic Models, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Patient Selection, Portal Vein, Postoperative Complications, Registries, Risk Adjustment, Treatment Outcome, Journal Article, Research Support, Non-U.S. Gov't",
author = "Michael Linecker and Bergthor Bj{\"o}rnsson and Stavrou, {Gregor A} and Oldhafer, {Karl J} and Georg Lurje and Ulf Neumann and Ren{\'e} Adam and Francois-Ren{\'e} Pruvot and Topp, {Stefan A} and Jun Li and Ivan Capobianco and Silvio Nadalin and Machado, {Marcel Autran} and Sergey Voskanyan and Deniz Balci and Roberto Hernandez-Alejandro and Alvarez, {Fernando A} and {De Santiba{\~n}es}, Eduardo and Ricardo Robles-Campos and Massimo Malag{\'o} and {de Oliveira}, {Michelle L} and Mickael Lesurtel and Pierre-Alain Clavien and Henrik Petrowsky",
year = "2017",
month = nov,
doi = "10.1097/SLA.0000000000002446",
language = "English",
volume = "266",
pages = "779--786",
journal = "ANN SURG",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

RIS

TY - JOUR

T1 - Risk Adjustment in ALPPS Is Associated With a Dramatic Decrease in Early Mortality and Morbidity

AU - Linecker, Michael

AU - Björnsson, Bergthor

AU - Stavrou, Gregor A

AU - Oldhafer, Karl J

AU - Lurje, Georg

AU - Neumann, Ulf

AU - Adam, René

AU - Pruvot, Francois-René

AU - Topp, Stefan A

AU - Li, Jun

AU - Capobianco, Ivan

AU - Nadalin, Silvio

AU - Machado, Marcel Autran

AU - Voskanyan, Sergey

AU - Balci, Deniz

AU - Hernandez-Alejandro, Roberto

AU - Alvarez, Fernando A

AU - De Santibañes, Eduardo

AU - Robles-Campos, Ricardo

AU - Malagó, Massimo

AU - de Oliveira, Michelle L

AU - Lesurtel, Mickael

AU - Clavien, Pierre-Alain

AU - Petrowsky, Henrik

PY - 2017/11

Y1 - 2017/11

N2 - 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 ≥10 cases over a period of ≥3 years were assessed for 90-day mortality and major interstage complications (≥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 < 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.

AB - 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 ≥10 cases over a period of ≥3 years were assessed for 90-day mortality and major interstage complications (≥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 < 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.

KW - Aged

KW - Colorectal Neoplasms

KW - Female

KW - Hepatectomy

KW - Humans

KW - Ligation

KW - Liver Neoplasms

KW - Logistic Models

KW - Longitudinal Studies

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Patient Selection

KW - Portal Vein

KW - Postoperative Complications

KW - Registries

KW - Risk Adjustment

KW - Treatment Outcome

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1097/SLA.0000000000002446

DO - 10.1097/SLA.0000000000002446

M3 - SCORING: Journal article

C2 - 28806301

VL - 266

SP - 779

EP - 786

JO - ANN SURG

JF - ANN SURG

SN - 0003-4932

IS - 5

ER -