• Henrik Petrowsky, Michael Linecker, Dimitri A Raptis, Christoph Kuemmerli, Ralph Fritsch, Onur E Kirimker, Deniz Balci, Francesca Ratti, Luca Aldrighetti, Sergey Voskanyan, Federico Tomassini, Roberto I Troisi, Jan Bednarsch, Georg Lurje, Mohammad-Hossein Fard-Aghaie, Tim Reese, Karl J Oldhafer, Omid Ghamarnejad, Arianeb Mehrabi, Abraham Mauro E Tun MET Department of Surgery, Division of HPB Surgery and Liver Transplantation, London Health Sciences Centre, London, Ontario, Canada., Stéphanie Truant, Francois-René Pruvot, Emir Hoti, Patryk Kambakamba, Ivan Capobianco, Silvio Nadalin, Eduardo S M Fernandes, Philipp Kron, Peter Lodge, Pim B Olthof, Thomas van Gulik, Carlos Castro-Benitez, René Adam, Marcel Autran Machado, Martin Teutsch, Jun Li, Marcus N Scherer, Hans J Schlitt, Victoria Ardiles, Eduardo de Santibañes, Roberto Brusadin, Victor Lopez-Lopez, Ricardo Robles-Campos, Massimo Malagó, Roberto Hernandez-Alejandro, and Pierre-Alain Clavien.
• Swiss HPB and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
• Ann. Surg. 2020 Nov 1; 272 (5): 793-800.

ObjectivesTo analyze long-term oncological outcome along with prognostic risk factors in a large cohort of patients with colorectal liver metastases (CRLM) undergoing ALPPS.BackgroundALPPS is a two-stage hepatectomy variant that increases resection rates and R0 resection rates in patients with primarily unresectable CRLM as evidenced in a recent randomized controlled trial. Long-term oncologic results, however, are lacking.MethodsCases in- and outside the International ALPPS Registry were collected and completed by direct contacts to ALPPS centers to secure a comprehensive cohort. Overall, cancer-specific (CSS), and recurrence-free (RFS) survivals were analyzed along with independent risk factors using Cox-regression analysis.ResultsThe cohort included 510 patients from 22 ALPPS centers over a 10-year period. Ninety-day mortality was 4.9% and median overall survival, CSS, and RFS were 39, 42, and 15 months, respectively. The median follow-up time was 38 months (95% confidence interval 32-43 months). Multivariate analysis identified tumor-characteristics (primary T4, right colon), biological features (K/N-RAS status), and response to chemotherapy (Response Evaluation Criteria in Solid Tumors) as independent predictors of CSS. Traditional factors such as size of metastases, uni versus bilobar involvement, and liver-first approach were not predictive. When hepatic recurrences after ALPPS was amenable to surgical/ablative treatment, median CSS was significantly superior compared to chemotherapy alone (56 vs 30 months, P < 0.001).ConclusionsThis large cohort provides the first evidence that patients with primarily unresectable CRLM treated by ALPPS have not only low perioperative mortality, but achieve appealing long-term oncologic outcome especially those with favorable tumor biology and good response to chemotherapy.

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