ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-center Study
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Published:2020-01-30
Issue:5
Volume:27
Page:1372-1384
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ISSN:1068-9265
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Container-title:Annals of Surgical Oncology
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language:en
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Short-container-title:Ann Surg Oncol
Author:
Li JunORCID, Moustafa Mohamed, Linecker Michael, Lurje Georg, Capobianco Ivan, Baumgart Janine, Ratti Francesca, Rauchfuss Falk, Balci Deniz, Fernandes Eduardo, Montalti Roberto, Robles-Campos Ricardo, Bjornsson Bergthor, Topp Stefan A., Fronek Jiri, Liu Chao, Wahba Roger, Bruns Christiane, Brunner Stefan M., Schlitt Hans J., Heumann Asmus, Stüben Björn-Ole, Izbicki Jakob R., Bednarsch Jan, Gringeri Enrico, Fasolo Elisa, Rolinger Jens, Kristek Jakub, Hernandez-Alejandro Roberto, Schnitzbauer Andreas, Nuessler Natascha, Schön Michael R., Voskanyan Sergey, Petrou Athanasios S., Hahn Oszkar, Soejima Yuji, Vicente Emilio, Castro-Benitez Carlos, Adam René, Tomassini Federico, Troisi Roberto Ivan, Kantas Alexandros, Oldhafer Karl Juergen, Ardiles Victoria, de Santibanes Eduardo, Malago Massimo, Clavien Pierre-Alain, Vivarelli Marco, Settmacher Utz, Aldrighetti Luca, Neumann Ulf, Petrowsky Henrik, Cillo Umberto, Lang Hauke, Nadalin Silvio
Abstract
Abstract
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.
Publisher
Springer Science and Business Media LLC
Reference49 articles.
1. Banales JM, Cardinale V, Carpino G, et al. Expert consensus document: cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). Nat Rev Gastroenterol Hepatol. 2016;13(5):261–80. 2. Cardinale V, Semeraro R, Torrice A, et al. Intra-hepatic and extra-hepatic cholangiocarcinoma: new insight into epidemiology and risk factors. World J Gastrointest Oncol. 15 2010;2(11):407–16. 3. Fitzmaurice C, Dicker D, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1(4):505-527. 4. Benson AB, 3rd, D’Angelica MI, Abbott DE, et al. NCCN guidelines insights: hepatobiliary cancers, version 1.2017. J Natl Compr Canc Netw. 2017;15(5):563–73. 5. Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol. 2014;60(6):1268–89.
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