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  • 1*Swiss HPB and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland †Department of Surgery, Linköping University, Linköping, Sweden ‡Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden §Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany ¶Semmelweis University Budapest, Campus Hamburg, Germany ||Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH Aachen, Aachen, Germany **Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France ††Department of Digestive Surgery and Transplantation, University Hospital, Lille, France ‡‡Department of Surgery, University Hospital Düsseldorf, Düsseldorf, Germany §§Department of Hepatobiliary Surgery and Transplantation University Medical Center Hamburg-Eppendorf Hamburg, Hamburg, Germany ¶¶Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany ||||Department of Surgery, University of São Paulo, São Paulo, Brazil ***Department of Surgery, A.I. Burnazyan FMBC Russian State Scientific Center of FMBA, Moscow, Russia †††Department of Surgery, Ankara University, Ankara, Turkey ‡‡‡Division of HPB Surgery and Liver Transplantation, Department of Surgery, London Health Sciences Centre, London, Ontario, Canada §§§Liver Transplant Unit, Division of HPB Surgery, Department of Surgery, Italian Hospital Buenos Aires, Buenos Aires, Argentina ¶¶¶Department of Surgery and Liver and Pancreas Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain ||||||Department of HPB- and Liver Transplantation Surgery, University College London, Royal Free Hospitals, London, UK ****Division of Transplantation, Hepatobiliary Surgery, University of Rochester, Rochester, USA.

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Summary
This summary is machine-generated.

Risk adjustment in Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) significantly reduced mortality and complications over time. These improvements align ALPPS outcomes with established standards for major liver surgery.

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Liver Transplantation

Background:

  • Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a two-stage hepatectomy for extensive liver tumors.
  • High reported mortality rates have led to criticisms and prompted adjustments in patient selection and surgical techniques.
  • Longitudinal data on the impact of these adjustments on outcomes were previously lacking.

Purpose of the Study:

  • To longitudinally assess the evolution of risk adjustment strategies in ALPPS.
  • To determine if these adjustments are associated with improved postoperative outcomes.
  • To evaluate changes in patient selection and surgical techniques over time.

Main Methods:

  • Analysis of data from 16 International ALPPS Registry centers performing ≥10 cases over ≥3 years (2009-2015).
  • Assessment of 90-day mortality and major interstage complications (≥3b).
  • Calculation of predicted mortality risks and a survey on center-specific risk adjustment strategies.

Main Results:

  • A shift in indications from biliary tumors to colorectal liver metastases was observed.
  • 90-day mortality decreased from 17% to 4% (P=0.002), and major complications decreased from 10% to 3% (P=0.011).
  • Reduced mortality was independently associated with risk-adjusted patient selection (OR: 1.62) and less invasive stage-1 techniques (OR: 0.39).

Conclusions:

  • Risk adjustment in patient selection and surgical technique has led to a continuous decrease in early mortality and morbidity in ALPPS.
  • Current ALPPS outcomes have reached accepted standards for major liver surgery.
  • The findings support the effectiveness of adaptive strategies in improving outcomes for complex liver resections.