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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
  • 39 Downloads

Abstract

Purpose

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.

Methods

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

Results

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.

Conclusion

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.

Keywords

Intrahepatic cholangiocarcinoma (iCCA) ALPPS Oncological outcome 

Abbreviations

AJCC

American Joint Committee on Cancer

ALPPS

Associating liver partition and portal vein ligation for staged hepatectomy

ALT

Alanine aminotransferase

AP

Alkaline phosphatase

ASA

American Society of Anesthesiologists

AST

Aspartate aminotransferase

BMI

Body mass index

BSA

Body surface area

BSC

Best supportive care

BW

Body weight

Cap

Capecitabine

cFLR

Calculated future liver remnant

CI

Confidence interval

Cis

Cisplatin

CRLM

Colorectal liver metastases

CRP

C-reactive protein

CT

Computed tomography

CUSA

Cavitron Ultrasonic Surgical Aspirator

DFS

Disease-free survival

EASL

European Association for Studies of the Liver

ECOG

Eastern Cooperative Oncology Group

FLR

Future liver remnant

GD-EOB-DPTA

Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid

Gem

Gemcitabine

GGT

Gamma glutamyltransferase

HCC

Hepatocellular carcinoma

INR

International normalized ratio

LiMAx

Maximum liver function capacity

MRCP

Magnetic resonance cholangiopancreatography

MRI

Magnetic resonance imaging

OS

Overall survival

Ox

Oxaliplatin

PET

Positron emission tomography

PVE

Portal vein embolization

RWTH

Rheinisch-Westfälische Technische Hochschule

SIRT

Selective internal radio therapy

SRT

Stereotactic radio therapy

TLV

Total liver volume

TR

Tumor recurrence

TSH/PVE

Two-stage hepatectomy with inter-stage portal vein embolization

UICC

Union for international cancer control

Notes

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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