Variation in complications and mortality following ALPPS at early-adopting centers

• Published in: HPB (Oxford, England) Vol. 23; no. 1; pp. 46 - 55
• Main Authors: Wanis, Kerollos N., Linecker, Michael, Madenci, Arin L., Müller, Philip C., Nüssler, Natascha, Brusadin, Roberto, Robles-Campos, Ricardo, Hahn, Oszkar, Serenari, Matteo, Jovine, Elio, Lehwald, Nadja, Knoefel, Wolfram T., Reese, Tim, Oldhafer, Karl, de Santibañes, Martin, Ardiles, Victoria, Lurje, Georg, Capelli, Rafaela, Enne, Marcelo, Ratti, Francesca, Aldrighetti, Luca, Zhurbin, Alexey S., Voskanyan, Sergey, Machado, Marcel, Kitano, Yuki, Adam, René, Chardarov, Nikita, Skipenko, Oleg, Ferri, Valentina, Vicente, Emilio, Tomiyama, Koji, Hernandez-Alejandro, Roberto
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-01-2021
• Subjects: Hepatectomy - adverse effects; Humans; Ligation; Liver Neoplasms - surgery; Portal Vein - diagnostic imaging; Portal Vein - surgery; Postoperative Complications - etiology; Registries; Treatment Outcome
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1016/j.hpb.2020.04.009

Various, often conflicting, estimates for post-operative morbidity and mortality following ALPPS have been reported in the literature, suggesting that considerable center-level variation exists. Some of this variation may be related to center volume and experience.
Using data from seventeen centers who were early adopters of the ALPPS technique, we estimated the variation, by center, in standardized 90-day mortality and comprehensive complication index (CCI) for patients treated between 2012 and 2018.
We estimated that center-specific 90-day mortality following treatment with ALPPS varied from 4.2% (95% CI: 0.8, 9.9) to 29.1% (95% CI: 13.9, 50.9), and that center-specific CCI following treatment with ALPPS varied from 17.0 (95% CI: 7.5, 26.5) to 49.8 (95% CI: 38.1, 61.8). Declines in estimated 90-day mortality and CCI were observed over time, and almost all individual centers followed this trend. Patients treated at centers with a higher number of ALPPS cases performed over the prior year had a lower risk of post-operative mortality.
Despite considerable center-level variation in ALPPS outcomes, perioperative outcomes following ALPPS have improved over time and treatment at higher volume centers results in a lower risk of 90-day mortality. Morbidity and mortality remain concerningly high at some centers.