Defining Benchmark Outcomes for ALPPS.

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Clinical benchmarking

Background:

• The Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy (ALPPS) procedure, used for unresectable liver tumors, faces safety concerns due to variable outcomes.
• Lack of standardized outcome references hinders objective assessment of ALPPS procedure safety and efficacy.

Purpose of the Study:

• To establish robust and standardized outcome benchmarks for the ALPPS procedure.
• To create reference values for evaluating ALPPS procedure safety and patient outcomes.

Main Methods:

• Benchmarking was applied to 120 selected cases from an international ALPPS registry.
• Benchmark values were defined as the 75th percentile of median outcomes from high-volume centers (≥30 cases).
• Criteria for benchmark cases included patient age (≤67 years), disease type (colorectal metastases), and absence of simultaneous abdominal procedures.

Main Results:

• Established benchmark values for key outcomes including stage 2 completion (≥96%), postoperative liver failure (≤5%), ICU stay (≤1 day stage 1, ≤2 days stage 2), and interstage interval (≤16 days).
• Defined benchmarks for hospital stay (≤10 days post-stage 2), overall morbidity (≤65%), major complications (≤38%), and 90-day comprehensive complication index (≤22).
• Set benchmarks for mortality (≤5% at 90 days) and survival rates (≥86% 1-year overall survival, ≥50% recurrence-free survival).

Conclusions:

• The benchmark analysis provides crucial reference values for the ALPPS procedure.
• These benchmarks indicate outcomes comparable to other major hepatectomies.
• The established cutoffs can be used for procedure comparison and assessing outcomes in higher-risk patient groups or alternative indications.