ALPPS Offers a Better Chance of Complete Resection in Patients with Primarily Unresectable Liver Tumors. Results of a Multicentre Analysis: Reply

Excerpt

We read with interest the letter by Rohatgi et al. concerning our study comparing ALPPS with PVE/PVL in a population with mixed liver tumors [1]. Our study does not focus only on colorectal liver metastases, as is suggested in the letter’s title. We studied a mixed population with different tumor etiologies. The authors main concern is the increased morbidity and mortality associated with ALPPS. They also take issues with a lack of adjustment for confounders in comparing the groups. The authors do not agree with our conclusion that rapid tumor removal in ALPPS may be advantageous, citing the argument frequently raised by the opponents of this new procedure, that failure to reach the second stage in staged procedures for cancer is just an unavoidable unmasking of the natural history of the disease [2]. Ultimately, they disagree that there is an advantage to ALPPS at all. …