Avoiding postoperative mortality after ALPPS-development of a tumor-specific risk score for colorectal liver metastases

HPB (Oxford). 2019 Jul;21(7):898-905. doi: 10.1016/j.hpb.2018.11.010. Epub 2019 Jan 2.


Background: ALPPS is a two-stage hepatectomy that induces more rapid liver growth compared to conventional strategies. This report aims to establish a risk-score to avoid adverse outcomes of ALPPS only for patients with colorectal liver metastases (CRLM) as primary indication for ALPPS.

Methods: All patients with CRLM included in the ALPPS registry were included. Risk score analysis was performed for 90-day mortality after ALPPS, defined as death within 90 days after either stage. Two risk scores were generated i.e. one for application before stage-1, and one for application before stage-2. Logistic regression analysis was performed to establish the risk-score.

Results: In total, 486 patients were included, of which 35 (7%) died 90 days after stage-1 or 2. In the stage-1 risk score, age ≥67 years (OR 3.7), FLR/BW ratio <0.40 (OR 2.9) and total center-volume (OR 2.4) were included. For the stage-2 score age ≥67 years (OR 3.7), FLR/BW ratio <0.40 (OR 2.8), bilirubin 5 days after stage-1 >50 μmol/L (OR 2.4), and stage-1 morbidity grade IIIA or higher (OR 6.3) were included.

Conclusions: The CRLM risk-score to predict mortality after ALPPS demonstrates that older patients with small remnant livers in inexperienced centers, especially after experiencing morbidity after stage-1 have adverse outcomes. The risk score may be used to restrict ALPPS to low-risk patient populations.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Argentina
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / pathology*
  • Europe
  • Female
  • Hepatectomy / adverse effects
  • Hepatectomy / mortality*
  • Humans
  • Ligation
  • Liver Neoplasms / mortality
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery*
  • Liver Regeneration
  • Male
  • Middle Aged
  • Portal Vein / pathology
  • Portal Vein / surgery*
  • Postoperative Complications / mortality*
  • Postoperative Complications / prevention & control
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Surgical Procedures / adverse effects
  • Vascular Surgical Procedures / mortality*