ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-center Study

  1. Li, Jun ORCID logo
  2. Moustafa, Mohamed
  3. Linecker, Michael
  4. Lurje, Georg
  5. Capobianco, Ivan
  6. Baumgart, Janine
  7. Ratti, Francesca
  8. Rauchfuss, Falk
  9. Balci, Deniz
  10. Fernandes, Eduardo
  11. Montalti, Roberto
  12. Robles-Campos, Ricardo
  13. Bjornsson, Bergthor
  14. Topp, Stefan A.
  15. Fronek, Jiri
  16. Liu, Chao
  17. Wahba, Roger
  18. Bruns, Christiane
  19. Brunner, Stefan M.
  20. Schlitt, Hans J.
  21. Heumann, Asmus
  22. Stüben, Björn-Ole
  23. Izbicki, Jakob R.
  24. Bednarsch, Jan
  25. Gringeri, Enrico
  26. Fasolo, Elisa
  27. Rolinger, Jens
  28. Kristek, Jakub
  29. Hernandez-Alejandro, Roberto
  30. Schnitzbauer, Andreas
  31. Nuessler, Natascha
  32. Schön, Michael R.
  33. Voskanyan, Sergey
  34. Petrou, Athanasios S.
  35. Hahn, Oszkar
  36. Soejima, Yuji
  37. Vicente, Emilio
  38. Castro-Benitez, Carlos
  39. Adam, René
  40. Tomassini, Federico
  41. Troisi, Roberto Ivan
  42. Kantas, Alexandros
  43. Oldhafer, Karl Juergen
  44. Ardiles, Victoria
  45. de Santibanes, Eduardo
  46. Malago, Massimo
  47. Clavien, Pierre-Alain
  48. Vivarelli, Marco
  49. Settmacher, Utz
  50. Aldrighetti, Luca
  51. Neumann, Ulf
  52. Petrowsky, Henrik
  53. Cillo, Umberto
  54. Lang, Hauke
  55. Nadalin, Silvio

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1000 Titel
  • ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-center Study
1000 Autor/in
  1. Li, Jun |
  2. Moustafa, Mohamed |
  3. Linecker, Michael |
  4. Lurje, Georg |
  5. Capobianco, Ivan |
  6. Baumgart, Janine |
  7. Ratti, Francesca |
  8. Rauchfuss, Falk |
  9. Balci, Deniz |
  10. Fernandes, Eduardo |
  11. Montalti, Roberto |
  12. Robles-Campos, Ricardo |
  13. Bjornsson, Bergthor |
  14. Topp, Stefan A. |
  15. Fronek, Jiri |
  16. Liu, Chao |
  17. Wahba, Roger |
  18. Bruns, Christiane |
  19. Brunner, Stefan M. |
  20. Schlitt, Hans J. |
  21. Heumann, Asmus |
  22. Stüben, Björn-Ole |
  23. Izbicki, Jakob R. |
  24. Bednarsch, Jan |
  25. Gringeri, Enrico |
  26. Fasolo, Elisa |
  27. Rolinger, Jens |
  28. Kristek, Jakub |
  29. Hernandez-Alejandro, Roberto |
  30. Schnitzbauer, Andreas |
  31. Nuessler, Natascha |
  32. Schön, Michael R. |
  33. Voskanyan, Sergey |
  34. Petrou, Athanasios S. |
  35. Hahn, Oszkar |
  36. Soejima, Yuji |
  37. Vicente, Emilio |
  38. Castro-Benitez, Carlos |
  39. Adam, René |
  40. Tomassini, Federico |
  41. Troisi, Roberto Ivan |
  42. Kantas, Alexandros |
  43. Oldhafer, Karl Juergen |
  44. Ardiles, Victoria |
  45. de Santibanes, Eduardo |
  46. Malago, Massimo |
  47. Clavien, Pierre-Alain |
  48. Vivarelli, Marco |
  49. Settmacher, Utz |
  50. Aldrighetti, Luca |
  51. Neumann, Ulf |
  52. Petrowsky, Henrik |
  53. Cillo, Umberto |
  54. Lang, Hauke |
  55. Nadalin, Silvio |
1000 Erscheinungsjahr 2020
1000 Publikationstyp
  1. Artikel |
1000 Online veröffentlicht
  • 2020-01-30
1000 Erschienen in
1000 Quellenangabe
  • 27(5):1372-1384
1000 Copyrightjahr
  • 2020
1000 Lizenz
1000 Verlagsversion
  • https://doi.org/10.1245/s10434-019-08192-z |
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138775/ |
1000 Publikationsstatus
1000 Sprache der Publikation
1000 Abstract/Summary
  • Background!#!ALPPS is found to increase the resectability of primary and secondary liver malignancy at the advanced stage. The aim of the study was to verify the surgical and oncological outcome of ALPPS for intrahepatic cholangiocarcinoma (ICC).!##!Methods!#!The study cohort was based on the ALPPS registry with patients from 31 international centers between August 2009 and January 2018. Propensity score matched patients receiving chemotherapy only were selected from the SEER database as controls for the survival analysis.!##!Results!#!One hundred and two patients undergoing ALPPS were recruited, 99 completed the second stage with median inter-stage duration of 11 days. The median kinetic growth rate was 23 ml/day. R0 resection was achieved in 87 (85%). Initially high rates of morbidity and mortality decreased steadily to a 29% severe complication rate and 7% 90-day morbidity in the last 2 years. Post-hepatectomy liver failure remained the main cause of 90-day mortality. Multivariate analysis revealed insufficient future liver remnant at the stage-2 operation (FLR2) to be the only risk factor for severe complications (OR 2.91, p = 0.02). The propensity score matching analysis showed a superior overall survival in the ALPPS group compared to palliative chemotherapy (median overall survival: 26.4 months vs 14 months; 1-, 2-, and 3-year survival rates: 82.4%, 70.5% and 39.6% vs 51.2%, 21.4% and 11.3%, respectively, p < 0.01). The survival benefit, however, was not confirmed in the subgroup analysis for patients with insufficient FLR2 or multifocal ICC.!##!Conclusion!#!ALPPS showed high efficacy in achieving R0 resections in locally advanced ICC. To get the most oncological benefit from this aggressive surgery, ALPPS would be restricted to patients with single lesions and sufficient FLR2.
1000 Sacherschließung
lokal Surgical Oncology
lokal Aged, 80 and over [MeSH]
lokal Aged [MeSH]
lokal Postoperative Complications/epidemiology [MeSH]
lokal Bile Ducts, Intrahepatic [MeSH]
lokal Surgical Wound Infection/epidemiology [MeSH]
lokal Proportional Hazards Models [MeSH]
lokal Male [MeSH]
lokal Bile Duct Neoplasms/surgery [MeSH]
lokal Postoperative Complications/prevention
lokal Portal Vein/surgery [MeSH]
lokal Propensity Score [MeSH]
lokal Surgery
lokal Cholangiocarcinoma/surgery [MeSH]
lokal Female [MeSH]
lokal SEER Program [MeSH]
lokal Adult [MeSH]
lokal Humans [MeSH]
lokal Treatment Outcome [MeSH]
lokal Palliative Care [MeSH]
lokal Ligation [MeSH]
lokal Middle Aged [MeSH]
lokal Oncology
lokal Postoperative Hemorrhage/epidemiology [MeSH]
lokal Survival Rate [MeSH]
lokal International Cooperation [MeSH]
lokal Ascites/epidemiology [MeSH]
lokal Hepatectomy/methods [MeSH]
lokal Antineoplastic Agents/therapeutic use [MeSH]
lokal Hepatobiliary Tumors
lokal Liver Failure/prevention
lokal Registries [MeSH]
1000 Liste der Beteiligten
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