The role of ALPPS in intrahepatic cholangiocarcinoma

  • Jan Bednarsch
  • Zoltan Czigany
  • Isabella Lurje
  • Pavel Strnad
  • Philipp Bruners
  • Tom Florian Ulmer
  • Marcel den Dulk
  • Georg LurjeEmail author
  • Ulf Peter Neumann
Original Article



Surgical resection constitutes the mainstay of curative treatment for intrahepatic cholangiocarcinoma (iCCA). Complete tumor clearance can only be achieved with extended liver resections and as such, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) may facilitate surgical resectability. The present study aims to evaluate the technical feasibility and oncologic outcome of ALPPS in iCCA.


A set of 14 patients who underwent ALPPS in a single center between 2011 and 2017 were statistically analyzed for perioperative and oncologic outcome.


Of all patients undergoing stage 1 of ALPPS, 12 (86%) patients were subsequently completed in stage 2 surgery. Patients who completed the ALPPS procedure showed a median overall survival (OS) of 4.2 years and a 3-year survival of 64%. Individuals without lymphatic metastases (n = 7) were all alive 1 year after surgery and if deceased, they died more than 4 years after surgery, while no patient with lymphatic metastases (n = 5) was alive 1 year after surgery.


This is the largest single-center experience of ALPPS in iCCA currently available in the literature showing excellent technical feasibility and encouraging overall survival in these patients.


Intrahepatic cholangiocarcinoma (iCCA) ALPPS Oncological outcome 



American Joint Committee on Cancer


Associating liver partition and portal vein ligation for staged hepatectomy


Alanine aminotransferase


Alkaline phosphatase


American Society of Anesthesiologists


Aspartate aminotransferase


Body mass index


Body surface area


Best supportive care


Body weight




Calculated future liver remnant


Confidence interval




Colorectal liver metastases


C-reactive protein


Computed tomography


Cavitron Ultrasonic Surgical Aspirator


Disease-free survival


European Association for Studies of the Liver


Eastern Cooperative Oncology Group


Future liver remnant


Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid




Gamma glutamyltransferase


Hepatocellular carcinoma


International normalized ratio


Maximum liver function capacity


Magnetic resonance cholangiopancreatography


Magnetic resonance imaging


Overall survival




Positron emission tomography


Portal vein embolization


Rheinisch-Westfälische Technische Hochschule


Selective internal radio therapy


Stereotactic radio therapy


Total liver volume


Tumor recurrence


Two-stage hepatectomy with inter-stage portal vein embolization


Union for international cancer control


Authors’ contributions

All the authors contributed significantly to this manuscript and are in agreement with the content. The authors contributed as follows: Study conception and design: JB, GL, UPN. Acquisition of data: JB, ZC, IL, MD. Analysis and interpretation of data: PS, TFU, GL. Drafting of manuscript: JB, GL, UPN. Critical revision of manuscript: PS, PB.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was conducted at the UH-RWTH in accordance with the requirements of the Institutional Review Board of the RWTH-Aachen University. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

423_2019_1838_MOESM1_ESM.docx (50 kb)
Table S1 (DOCX 49 kb)
423_2019_1838_MOESM2_ESM.docx (50 kb)
Table S2 (DOCX 50 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
  2. 2.Department of Medicine IIIUniversity Hospital RWTH AachenAachenGermany
  3. 3.Department of RadiologyUniversity Hospital RWTH AachenAachenGermany
  4. 4.Department of SurgeryMaastricht University Medical Centre (MUMC)MaastrichtNetherlands

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