ALPPS Versus PVE/PL

NCT ID: NCT02215577

Last Updated: 2014-08-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-06-30

Study Completion Date

2018-12-31

Brief Summary

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Study Title Comparison of two different models of liver growth stimulation in advanced colorectal liver metastatic disease, (LIGRO Trial) enabling liver resection

Methodology Scandinavian Multiple Center Randomized Registry Based Clinical Trial

Study duration The planned duration of study participation for an individual subject from inclusion to follow-up are 3 years

Primary investigator:

Per Sandstrom (Linköping)

Number of subjects 100 patients randomized in a 1:1 randomization

Diagnosis and main inclusion criteria Patients with colorectal liver metastasis requiring liver resection, but are not resectable in one step because of a future liver remnant/standardized total liver volume of \< 30 % extrahepatic metastatic disease is not an exclusion criteria if they can be addressed surgically in the future

Overall goal To evaluate if the ALPPS approach is superior to PVE in enabling patients, primarily unresectable due to inadequate FLR, to be resected and reach an R0 situation with an acceptable level of complications and perioperative mortality.

To evaluate if the ALPPS approach increases the growth rate of the liver compared to portal embolization or portal ligation leading to a shorter treatment period.

In addition the investigators aim to study if ALPPS may reach these goals without detectable or improved differences in tumor activity (PFS and OS), but with a shorter recovery and a higher proportion of patients reaching R0.

Hypothesis A higher proportion of patients can be resected with ALPPS counted as rate resected compared to the previously established methods with portal ligation or embolization.

This increased resection rate will not reduce the R0 rate, or increase the rate of Clavien grade 4 complication or higher (H0).

The ALPPS approach will increase the growth rate compared to portal embolization/ligation measured one week after the primary intervention.

Detailed Description

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Conditions

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Colorectal Cancer Liver Metastases

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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In-situ split with portal vein ligature

In-situ liver split at time when portal vein ligature is performed

Group Type EXPERIMENTAL

In-situ split

Intervention Type PROCEDURE

The portal branches to the diseased side should be completely divided. The bile duct to the diseased side should not be divided. The parenchyma should be transected all the way through the transection plane and place a plastic sheet on the diseased transection surface.

Portal embolization or ligation

Intervention: Preoperative portal embolization (+/-ablation) followed by liver resection, or local resections and/or ablations followed by lobectomy, two-stage hepatectomy

Group Type ACTIVE_COMPARATOR

Portal embolization or ligation

Intervention Type PROCEDURE

Portal vein embolization is performed according to the intervention used at the different sites.

Interventions

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In-situ split

The portal branches to the diseased side should be completely divided. The bile duct to the diseased side should not be divided. The parenchyma should be transected all the way through the transection plane and place a plastic sheet on the diseased transection surface.

Intervention Type PROCEDURE

Portal embolization or ligation

Portal vein embolization is performed according to the intervention used at the different sites.

Intervention Type PROCEDURE

Other Intervention Names

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ALPPS

Eligibility Criteria

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Inclusion Criteria

1. By liver tumor board found accepted for inclusion
2. Patients with a tumor burden of colorectal liver metastasis
3. Signed informed content
4. Colorectal liver metastatic disease with an estimated FLR/sTLV of \<30%
5. Primary tumor and any extrahepatic disease possible to resect in patients with liver first approach or after resection of primary tumor.

Exclusion Criteria

1. Cirrhosis
2. Significant comorbidity rendering subjects unsuitable for major surgery
3. Progressive disease after preoperative oncological treatment
4. Age\<18 years
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Regionalt Cancercentrum Väst

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Departments of Surgical Gastroenterology and Transplantation

Copenhagen, , Denmark

Site Status RECRUITING

Rikshospitalet Oslo University Hospital

Oslo, , Norway

Site Status RECRUITING

Sahlgrenska University Hospital

Gothenburg, , Sweden

Site Status RECRUITING

Department of Surgery, Linkoping University Hospital

Linköping, , Sweden

Site Status RECRUITING

Department of Surgery, University Hospital

Lund, , Sweden

Site Status RECRUITING

Karolinska University Hospital

Stockholm, , Sweden

Site Status RECRUITING

Norrland University Hospital

Umeå, , Sweden

Site Status RECRUITING

Countries

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Denmark Norway Sweden

Central Contacts

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Per Sandstrom, MD, PhD

Role: CONTACT

+46 73 4058581

Magnus Rizell, MD, Phd

Role: CONTACT

+46705259301

Facility Contacts

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Bard Rosak, MD, PhD

Role: primary

Magnus Rizell

Role: primary

Per Sandstrom, PhD, MD

Role: primary

Gert Lindell, MD, PhD

Role: primary

+46707190077

Bengt Isaksson, MD, PhD

Role: primary

Bjarne Andnor, MD

Role: primary

References

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Hasselgren K, Rosok BI, Larsen PN, Sparrelid E, Lindell G, Schultz NA, Bjornbeth BA, Isaksson B, Larsson AL, Rizell M, Bjornsson B, Sandstrom P. Response to Comment on: Hasselgren K, et al ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM: Survival Analysis From the Randomized Controlled Trial LIGRO. Ann Surg. 2021;273(3):442-448. Ann Surg. 2022 Nov 1;276(5):e632-e633. doi: 10.1097/SLA.0000000000005268. Epub 2021 Oct 20. No abstract available.

Reference Type DERIVED
PMID: 35129514 (View on PubMed)

Other Identifiers

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SweLiv 1-2014

Identifier Type: -

Identifier Source: org_study_id

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