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Long-Term Outcome After Conventional Two-Stage Hepatectomy Versus Tourniquet-ALPPS in Colorectal Liver Metastases: A Propensity Score Matching Analysis.
Robles-Campos, Ricardo; Brusadin, Roberto; López-Conesa, Asunción; López-López, Víctor; Navarro-Barrios, Álvaro; López-Espín, José J; Arévalo-Pérez, Julio; Parrilla, Pascual.
Afiliación
  • Robles-Campos R; Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain. rirocam@um.es.
  • Brusadin R; Department of Surgery, Virgen de La Arrixaca Clinic, University Hospital, El Palmar, Murcia, Spain. rirocam@um.es.
  • López-Conesa A; Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain.
  • López-López V; Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain.
  • Navarro-Barrios Á; Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain.
  • López-Espín JJ; Department of Liver Surgery and Transplantation, Virgen de La Arrixaca Clinic, University Hospital, IMIB-Arrixaca, Murcia, Spain.
  • Arévalo-Pérez J; Miguel Hernandez University, Elche, Alicante, Spain.
  • Parrilla P; Radiology Department, Memorial Sloan Kettering Cancer Center, New York, USA.
World J Surg ; 43(9): 2281-2289, 2019 09.
Article en En | MEDLINE | ID: mdl-31119359
BACKGROUND: To compare the overall survival (OS) and disease-free survival (DFS) of Tourniquet-ALPPS (T-ALPPS) and conventional two-stage hepatectomy (TSH) in patients with colorectal liver metastases (CRLM). METHODS: A retrospective study from a prospectively collected database was performed between October 2000 and July 2016. TSH was performed before September 2011, after which time T-ALPPS became the technique of choice. A propensity score matching (PSM) was performed based on a 1:1 ratio with consideration of the following variables: number and size of metastases, bilobar disease presence, and chemotherapy received. RESULTS: Thirty-four patients received T-ALPPS; 41 patients received TSH. After PSM, 21 patients remained in each group, with 100% resectability in the T-ALPPS group and 90.5% resectability in the TSH group. The median OS for TSH was 41 months; for T-ALPPS, the median OS was 36 months (P = 0.925). The median DFS was 16 months in the TSH group; the median DFS was 9 months in the T-ALPPS group (P = 0.930). The 1-, 3-, and 5-year OS for TSH was 81%, 66.7%, and 23.8% vs. 76.2%, 57.1%, and 22.9% for T-ALPPS, respectively. The 1-, 3-, and 5-year DFS for TSH was 66.7%, 9.5%, and 5% vs. 44.6%, 11.1%, and 11.1% for T-ALPPS, respectively. The volume increase with T-ALPPS was superior to that with TSH (68% vs. 39%; P = 0.018). There were no differences in morbidity and mortality after stages 1 and 2. CONCLUSIONS: T-ALPPS produces a similar outcome to TSH, indicating that it could be a safe and effective alternative for curative hepatectomy for all patients.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Torniquetes / Neoplasias Colorrectales / Puntaje de Propensión / Hepatectomía / Neoplasias Hepáticas Tipo de estudio: Observational_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: World J Surg Año: 2019 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Torniquetes / Neoplasias Colorrectales / Puntaje de Propensión / Hepatectomía / Neoplasias Hepáticas Tipo de estudio: Observational_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: World J Surg Año: 2019 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos