Background:Primarily unresectable liver tumors may be approached by the Associating Liver Partition and Portal vein Ligation for Staged Hepatectomy(ALPPS)procedure.Post-hepatectomy liver failure(PHLF)poses the most si...Background:Primarily unresectable liver tumors may be approached by the Associating Liver Partition and Portal vein Ligation for Staged Hepatectomy(ALPPS)procedure.Post-hepatectomy liver failure(PHLF)poses the most significant risk factor for poor outcomes.The AST-to-platelets ratio index(APRI)/albumin-to-bilirubin index(ALBI)score has been proposed as an easy and routinely available score to monitor liver function.Here,we explored the predictive capability of the APRI/ALBI score to determine PHLF and perioperative morbidity to help determine the optimal timing of the 2nd stage of ALPPS.Methods:Based on the international multicenter ALPPS registry,patients from 2012 to 2020 with an available APRI/ALBI score were included.Postoperative outcomes clinically relevant PHLF B+C,90-day mortality,and severe morbidity(≥Clavien-Dindo 3b)after ALPPS stage II were assessed.The APRI/ALBI score was monitored perioperatively,and the predictive value was evaluated using logistic regression and receiver operating characteristics.Performance of APRI/ALBI score was compared to the ALPPS futility risk score in this cohort study.Results:Overall,464 patients from 16 participating centers were included.Clinically relevant PHLF(B+C)was observed in 7.5% of patients,of which 63% ultimately died.After stage I,the APRI/ALBI score gradually recovered.The pre-stage II APRI/ALBI score significantly predicted clinically relevant PHLF[area under the curve(AUC)=0.78;P<0.001],90-day mortality(AUC=0.67;P=0.002),and severe morbidity(AUC=0.65;P<0.001).Three clinically relevant APRI/ALBI score risk groups were defined:clinically relevant PHLF occurred in 3.1%in the low-,8.7%in the intermediate-,and 28.0%in the high-risk groups.90-day mortality was 6.8%in the low-,15.9% in the intermediate-,and 19.4%in the high-risk groups.Integrated assessment of the established futility risk score in combination with the APRI/ALBI score documented further increased predictive potential for clinically relevant PHLF(AUC 0.81;P<0.001).Conclusions:The APRI/ALBI score allows for simple and dynamic liver function recovery monitoring after the first ALPPS stage.Inadequate recovery of the APRI/ALBI score until ALPPS stage II was associated with PHLF B+C,90-day mortality,and severe morbidity.With the proposed risk model,optimized timing of the second stage of ALPPS may further increase the safety of this procedure.展开更多
文摘Background:Primarily unresectable liver tumors may be approached by the Associating Liver Partition and Portal vein Ligation for Staged Hepatectomy(ALPPS)procedure.Post-hepatectomy liver failure(PHLF)poses the most significant risk factor for poor outcomes.The AST-to-platelets ratio index(APRI)/albumin-to-bilirubin index(ALBI)score has been proposed as an easy and routinely available score to monitor liver function.Here,we explored the predictive capability of the APRI/ALBI score to determine PHLF and perioperative morbidity to help determine the optimal timing of the 2nd stage of ALPPS.Methods:Based on the international multicenter ALPPS registry,patients from 2012 to 2020 with an available APRI/ALBI score were included.Postoperative outcomes clinically relevant PHLF B+C,90-day mortality,and severe morbidity(≥Clavien-Dindo 3b)after ALPPS stage II were assessed.The APRI/ALBI score was monitored perioperatively,and the predictive value was evaluated using logistic regression and receiver operating characteristics.Performance of APRI/ALBI score was compared to the ALPPS futility risk score in this cohort study.Results:Overall,464 patients from 16 participating centers were included.Clinically relevant PHLF(B+C)was observed in 7.5% of patients,of which 63% ultimately died.After stage I,the APRI/ALBI score gradually recovered.The pre-stage II APRI/ALBI score significantly predicted clinically relevant PHLF[area under the curve(AUC)=0.78;P<0.001],90-day mortality(AUC=0.67;P=0.002),and severe morbidity(AUC=0.65;P<0.001).Three clinically relevant APRI/ALBI score risk groups were defined:clinically relevant PHLF occurred in 3.1%in the low-,8.7%in the intermediate-,and 28.0%in the high-risk groups.90-day mortality was 6.8%in the low-,15.9% in the intermediate-,and 19.4%in the high-risk groups.Integrated assessment of the established futility risk score in combination with the APRI/ALBI score documented further increased predictive potential for clinically relevant PHLF(AUC 0.81;P<0.001).Conclusions:The APRI/ALBI score allows for simple and dynamic liver function recovery monitoring after the first ALPPS stage.Inadequate recovery of the APRI/ALBI score until ALPPS stage II was associated with PHLF B+C,90-day mortality,and severe morbidity.With the proposed risk model,optimized timing of the second stage of ALPPS may further increase the safety of this procedure.
