Early survival and safety of ALPPS first report of the international ALPPS registry

Erik Schadde, Victoria Ardiles, Ricardo Robles-Campos, Massimo Malago, Marcel Machado, Roberto Hernandez-Alejandro, Olivier Soubrane, Andreas A. Schnitzbauer, Dimitri Raptis, Christoph Tschuor, Henrik Petrowsky, Eduardo De Santibanes, Pierre Alain Clavien, Eddie Abdalla, Rene Adam, Dmitri Alden, Luca Antonio Aldrighetti, Emilio Alvarez Prida De Paz, Silvio Balzan, Jeffrey BarkunBergthor Björnsson, Carlos Castro-Benitez, Raffaele Brustia, William C. Chapman, Nikita Chardarov, Denis Chaychenko, Daniel Cherqui, Laura Corradetti, Kris Croome, Esteban Cugat, Jiahong Dong, Vincent Donckier, Alexandre Doussot, Marcelo Enne, Joan Figueras, Erik Herrero Fonollosa, Riccardo Gauzolino, Thomas Gruenberger, Xavier Maximilien Keutgen, Alan Koffron, Norihiro Kukudo, Javier Lendoire, Jun Li, J. Peter A. Lodge, Susan Logan, Dario Lorenzin, Valerio Lucidi, Georg Lurje, Michele Masetti, Lucas McCormack, Roberto Montalti, Masato Nagino, Natascha Nüssler, Klinikum Neuperlach, Pablo Ortega-Deballon, Karen Pineda, Theodora Pissanou, Francesca Ratti, Jean Marc Regimbeau, Xavier Rogiers, Yoshihiro Sakamoto, Per Sandström, Julio Santoyo, Olivier Scatton, Gregory Sergeant, Alejandro Serrablo, Dinesh Sharma, Oleg Skipenko, Evgeny Solomonov, Ernesto Sparrelid, Stojanovic Stojanovic, Steven Strassberg, Hans Torrenga, Roberto Troisi, Stéphanie Truant, Neeta Vachharajani, Eduardo Viana De Carvalho, Eric Vibert, Emilio Vicente, Marco Vivarelli, Soumil Vyas, Zhang Wen, Wang Zheng, Jian Zhou

Research output: Contribution to journalArticlepeer-review

373 Scopus citations


Objectives: To assess safety and outcomes of the novel 2-stage hepatectomy, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), using an international registry. Background: ALPPS induces accelerated growth of small future liver remnants (FLR) to allow curative resection of liver tumors. There is concern about safety based on reports of higher morbidity and mortality. Methods: A Web-based data entry system was created with password access and data pseudoencryption (NCT01924741). All patients with complete 90-day data were included. Multivariate logistic regression analysis was performed to identify independent risk factors for severe complications and mortality and volume growth of the FLR. Results: Complete data were available for 202 patients. A total of 141 (70%) patients had colorectal liver metastases (CRLM). Median starting standardized future liver remnants of 21% increased by 80% within a median of 7 days. Ninety-day mortality was 19/202 (9%). Severe complications including mortalities (Clavien-Dindo ≥IIIb) occurred in 27% of patients. Independent factors for severe complications were red blood cell transfusion [odds ratio (OR), 5.2), ALPPS stage I operating time greater than 300 minutes (OR, 4.4), age more than 60 years (OR, 3.8), and non-CRLM (OR, 2.7). Age, use of Pringle maneuver, and histologic changes led to less volume growth. In patients younger than 60 years with CRLM, 90-day mortality was similar to conventional 2-stage hepatectomies for CRLM. Conclusions: This is the first analysis of the ALPPS registry showing that ALPPS has increased perioperative morbidity and mortality in older patients but better outcomes in patients with CRLM.

Original languageEnglish
Pages (from-to)829-838
Number of pages10
JournalAnnals of surgery
Issue number5
StatePublished - 2014


  • Alpps
  • Hepatectomy
  • Hypertrophy
  • Liver tumors
  • Portal vein (qualifier surgery)


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