Expert’s introduction Prof.Henrik Petrowsky(Figure 1)is a Professor of Surgery and Vice-Chair of the Department of Surgery and Transplantation at the University of Zürich,Switzerland.He serves as Program Directo...Expert’s introduction Prof.Henrik Petrowsky(Figure 1)is a Professor of Surgery and Vice-Chair of the Department of Surgery and Transplantation at the University of Zürich,Switzerland.He serves as Program Director of the HPB Surgery and Liver Transplant Fellowship at the Swiss HPB and Transplant Center Zurich.Prof.Petrowsky is heading the Liver and Pancreas Tumor Center,which is embedded in the Comprehensive Cancer Center Zurich at the University Hospital Zurich.His current practice consists of liver transplantation and HPB surgery.His research interests have mirrored his clinical work mainly focusing on translational and outcome research in liver transplantation and hepatobiliary surgery.展开更多
Background:Preoperative patient selection in Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)is not always reliable with currently available scores,particularly in patients with prima...Background:Preoperative patient selection in Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)is not always reliable with currently available scores,particularly in patients with primary liver tumor.This study aims to(I)to determine whether comorbidities and patients characteristics are a risk factor in ALPPS and(II)to create a score predicting 90-day mortality preoperatively.Methods:Thirteen high-volume centers participated in this retrospective multicentric study.A risk analysis based on patient characteristics,underlying disease and procedure type was performed to identify risk factors and model the Comprehensive ALPPS Preoperative Risk Assessment(CAPRA)score.A nonparametric receiver operating characteristic analysis was performed to estimate the predictive ability of our score against the Charlson Comorbidity Index(CCI),the age-adjusted CCI(aCCI),the ALPPS risk score before Stage 1(ALPPS-RS1)and Stage 2(ALPPS-RS2).The model was internally validated applying bootstrapping.Results:A total of 451 patients were included.Mortality was 14.4%.The CAPRA score is calculated based on the following formula:(0.1×age)−(2×BSA)+1(in the presence of primary liver tumor)+1(in the presence of severe cardiovascular disease)+2(in the presence of moderate or severe diabetes)+2(in the presence of renal disease)+2(if classic ALPPS is planned).The predictive ability was 0.837 for the CAPRA score,0.443 for CCI,0.519 for aCCI,0.693 for ALPPS-RS1 and 0.807 for ALPPS-RS2.After 1,000 cycles of bootstrapping the C statistic was 0.793.The accuracy plot revealed a cut-off for optimal prediction of postoperative mortality of 4.70.Conclusions:Comorbidities play an important role in ALPPS and should be carefully considered when planning the procedure.By assessing the patient’s preoperative condition in relation to ALPPS,the CAPRA score has a very good ability to predict postoperative mortality.展开更多
Life expectancy of patients with colorectal liver metastasis(CRLM)significantly improved over the last decades due to the induction of multimodal effective treatment strategies including perioperative chemotherapy and...Life expectancy of patients with colorectal liver metastasis(CRLM)significantly improved over the last decades due to the induction of multimodal effective treatment strategies including perioperative chemotherapy and advanced surgical procedures.By conversion chemotherapy,previously unresectable CRLMs can be converted to a resectable situation and amenable to procedures such as associating liver partition and portal vein ligation(ALPPS)(1).A recent publication in HBSN has extensively reviewed ALPPS as a concept in the treatment of CRLM.This review article by Glinka et al.(2)focuses on the evolvement of this novel procedure and describes in detail the gradual changes accompanying this procedure’s evolvement since 2007.Further,the authors highlight several aspects crucial for the best possible outcome after this procedure including patient selection,future liver remnant,technical aspects,safety,morbidity,mortality and oncological results.展开更多
文摘Expert’s introduction Prof.Henrik Petrowsky(Figure 1)is a Professor of Surgery and Vice-Chair of the Department of Surgery and Transplantation at the University of Zürich,Switzerland.He serves as Program Director of the HPB Surgery and Liver Transplant Fellowship at the Swiss HPB and Transplant Center Zurich.Prof.Petrowsky is heading the Liver and Pancreas Tumor Center,which is embedded in the Comprehensive Cancer Center Zurich at the University Hospital Zurich.His current practice consists of liver transplantation and HPB surgery.His research interests have mirrored his clinical work mainly focusing on translational and outcome research in liver transplantation and hepatobiliary surgery.
基金The study was approved by Independent Ethics Committee(IEC)of Tübingen University Hospital(No.030/2019A)and informed。
文摘Background:Preoperative patient selection in Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)is not always reliable with currently available scores,particularly in patients with primary liver tumor.This study aims to(I)to determine whether comorbidities and patients characteristics are a risk factor in ALPPS and(II)to create a score predicting 90-day mortality preoperatively.Methods:Thirteen high-volume centers participated in this retrospective multicentric study.A risk analysis based on patient characteristics,underlying disease and procedure type was performed to identify risk factors and model the Comprehensive ALPPS Preoperative Risk Assessment(CAPRA)score.A nonparametric receiver operating characteristic analysis was performed to estimate the predictive ability of our score against the Charlson Comorbidity Index(CCI),the age-adjusted CCI(aCCI),the ALPPS risk score before Stage 1(ALPPS-RS1)and Stage 2(ALPPS-RS2).The model was internally validated applying bootstrapping.Results:A total of 451 patients were included.Mortality was 14.4%.The CAPRA score is calculated based on the following formula:(0.1×age)−(2×BSA)+1(in the presence of primary liver tumor)+1(in the presence of severe cardiovascular disease)+2(in the presence of moderate or severe diabetes)+2(in the presence of renal disease)+2(if classic ALPPS is planned).The predictive ability was 0.837 for the CAPRA score,0.443 for CCI,0.519 for aCCI,0.693 for ALPPS-RS1 and 0.807 for ALPPS-RS2.After 1,000 cycles of bootstrapping the C statistic was 0.793.The accuracy plot revealed a cut-off for optimal prediction of postoperative mortality of 4.70.Conclusions:Comorbidities play an important role in ALPPS and should be carefully considered when planning the procedure.By assessing the patient’s preoperative condition in relation to ALPPS,the CAPRA score has a very good ability to predict postoperative mortality.
文摘Life expectancy of patients with colorectal liver metastasis(CRLM)significantly improved over the last decades due to the induction of multimodal effective treatment strategies including perioperative chemotherapy and advanced surgical procedures.By conversion chemotherapy,previously unresectable CRLMs can be converted to a resectable situation and amenable to procedures such as associating liver partition and portal vein ligation(ALPPS)(1).A recent publication in HBSN has extensively reviewed ALPPS as a concept in the treatment of CRLM.This review article by Glinka et al.(2)focuses on the evolvement of this novel procedure and describes in detail the gradual changes accompanying this procedure’s evolvement since 2007.Further,the authors highlight several aspects crucial for the best possible outcome after this procedure including patient selection,future liver remnant,technical aspects,safety,morbidity,mortality and oncological results.
