Pim B Olthof1, Robert J S Coelen2, Jimme K Wiggers2, Bas Groot Koerkamp3, Massimo Malago4, Roberto Hernandez-Alejandro5, Stefan A Topp6, Marco Vivarelli7, Luca A Aldrighetti8, Ricardo Robles Campos9, Karl J Oldhafer10, William R Jarnagin11, Thomas M van Gulik2. 1. Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: p.b.olthof@amc.nl. 2. Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. 4. Department of HPB and Liver Transplant Surgery, Royal Free Hospital, University College London, London, United Kingdom. 5. Department of Surgery, Western University Medical Center, London, Ontario, Canada; Devision of Transplantation, University of Rochester, New York, United States. 6. Department of Surgery, University Hospital Düsseldorf, Germany. 7. Department of Surgery, Azienda Ospedaliero Universitaria - Ospedali Riuniti di Ancona, Ancona, Italy. 8. Department of Surgery, San Raffaele Hospital, Milano, Italy. 9. Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain. 10. Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Faculty of Medicine, Semmelweis University Campus Hamburg, Germany. 11. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States.
Abstract
INTRODUCTION: Resection of perihilar cholangiocarcinoma (PHC) entails high-risk surgery with postoperative mortality reported up to 18%, even in specialized centers. The aim of this study was to compare outcomes of PHC patients who underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to patients who underwent resection without ALPPS. METHODS: All patients who underwent ALPPS for PHC were identified from the international ALPPS registry and matched controls were selected from a standard resection cohort from two centers based on future remnant liver size. Outcomes included morbidity, mortality, and overall survival. RESULTS: ALPPS for PHC was associated with 48% (14/29) 90-day mortality. 90-day mortality was 13% in 257 patients who underwent major liver resection for PHC without ALPPS. The 29 ALPPS patients were matched to 29 patients resected without ALPPS, with similar future liver remnant volume (P = 0.480). Mortality in the matched control group was 24% (P = 0.100) and median OS was 27 months, comparted to 6 months after ALPPS (P = 0.064). DISCUSSION: Outcomes of ALPPS for PHC appear inferior compared to standard extended resections in high-risk patients. Therefore, portal vein embolization should remain the preferred method to increase future remnant liver volume in patients with PHC. ALPPS is not recommended for PHC.
INTRODUCTION: Resection of perihilar cholangiocarcinoma (PHC) entails high-risk surgery with postoperative mortality reported up to 18%, even in specialized centers. The aim of this study was to compare outcomes of PHC patients who underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to patients who underwent resection without ALPPS. METHODS: All patients who underwent ALPPS for PHC were identified from the international ALPPS registry and matched controls were selected from a standard resection cohort from two centers based on future remnant liver size. Outcomes included morbidity, mortality, and overall survival. RESULTS: ALPPS for PHC was associated with 48% (14/29) 90-day mortality. 90-day mortality was 13% in 257 patients who underwent major liver resection for PHC without ALPPS. The 29 ALPPS patients were matched to 29 patients resected without ALPPS, with similar future liver remnant volume (P = 0.480). Mortality in the matched control group was 24% (P = 0.100) and median OS was 27 months, comparted to 6 months after ALPPS (P = 0.064). DISCUSSION: Outcomes of ALPPS for PHC appear inferior compared to standard extended resections in high-risk patients. Therefore, portal vein embolization should remain the preferred method to increase future remnant liver volume in patients with PHC. ALPPS is not recommended for PHC.
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