Abstract：
ALPPS enables complete tumor resection in a shorter interval and a larger number of patients than classic two-stage hepatectomies. However, there is little evidence regarding long-term outcomes in patients with colorectal liver metastases (CLM). This study aims to evaluate the short and long-term outcomes of ALPPS in patients with CRM. Single-cohort, prospective, observational study. Patients with unresectable CLM due to insufficient liver remnant who underwent ALPPS between June 2011 and June 2021 were included. Of 32 patients treated, 21 were male (66%) and the median age was 56 years (range = 29-81). Both stages were completed in 30 patients (93.7%), with an R0 rate of 75% (24/32). Major morbidity was 37.5% and the mortality nil. Median overall survival (OS) and recurrence-free survival (RFS) were 28.1 and 8.8 months, respectively. The 1-3, and 5-year OS was 86%, 45%, and 21%, and RFS was 42%, 14%, and 14%, respectively. The only independent risk factor associated with poor RFS (5.7 vs 11.6 months; p = 0.038) and OS (15 vs 37 months; p = 0.009) was not receiving adjuvant chemotherapy. KRAS mutation was associated with worse OS from disease diagnosis (24.3 vs. 38.9 months; p = 0.025). ALPPS is associated with favorable oncological outcomes, comparable to traditional strategies to increase resectability in patients with CLM and high tumor burden. Our results suggest for the first time that adjuvant chemotherapy is independently associated with better short- and long-term outcomes after ALPPS. Selection of patients with KRAS mutations should be performed with caution, as this could affect oncological outcomes.
摘要：
与经典的两阶段肝切除术相比，ALPPS可以在更短的时间间隔和更多的患者中进行完整的肿瘤切除。然而,关于结直肠癌肝转移(CLM)患者的长期结局的证据很少.本研究旨在评估CRM患者ALPPS的短期和长期结果。单个队列,prospective,观察性研究。包括在2011年6月至2021年6月期间因肝脏残存量不足而无法切除的CLM患者。在接受治疗的32名患者中，21人为男性（66％），中位年龄为56岁（范围=29-81）。这两个阶段都完成了30例（93.7％），R0率为75%(24/32)。主要发病率为37.5%，死亡率为零。中位总生存期（OS）和无复发生存期（RFS）分别为28.1和8.8个月，分别。1-3和5年OS为86%，45%,21%,RFS是42%,14%,14%,分别。与不良RFS（5.7vs11.6个月；p=0.038）和OS（15vs37个月；p=0.009）相关的唯一独立危险因素是未接受辅助化疗。KRAS突变与疾病诊断的OS差相关（24.3与38.9个月；p=0.025）。ALPPS与良好的肿瘤学结果相关，与传统策略相比，可以提高CLM和高肿瘤负荷患者的可切除性。我们的结果首次表明，辅助化疗与ALPPS后更好的短期和长期预后独立相关。选择有KRAS突变的患者应谨慎，因为这可能会影响肿瘤的结果。
