Li, Jun ORCID: 0000-0003-1553-8105, Moustafa, Mohamed ORCID: 0000-0001-9912-0878, Linecker, Michael ORCID: 0000-0002-0721-6811, 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, Stueben, Bjoern-Ole, Izbicki, Jakob R., Bednarsch, Jan, Gringeri, Enrico, Fasolo, Elisa, Rolinger, Jens, Kristek, Jakub ORCID: 0000-0002-3758-2273, Hernandez-Alejandro, Roberto, Schnitzbauer, Andreas, Nuessler, Natascha, Schoen, Michael R., Voskanyan, Sergey, Petrou, Athanasios S., Hahn, Oszkar, Soejima, Yuji, Vicente, Emilio, Castro-Benitez, Carlos, Adam, Rene, 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 and Nadalin, Silvio (2020). ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-center Study. Ann. Surg. Oncol., 27 (5). S. 1372 - 1385. NEW YORK: SPRINGER. ISSN 1534-4681

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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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Li, JunUNSPECIFIEDorcid.org/0000-0003-1553-8105UNSPECIFIED
Moustafa, MohamedUNSPECIFIEDorcid.org/0000-0001-9912-0878UNSPECIFIED
Linecker, MichaelUNSPECIFIEDorcid.org/0000-0002-0721-6811UNSPECIFIED
Lurje, GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Capobianco, IvanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baumgart, JanineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ratti, FrancescaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rauchfuss, FalkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Balci, DenizUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fernandes, EduardoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Montalti, RobertoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Robles-Campos, RicardoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bjornsson, BergthorUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Topp, Stefan A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fronek, JiriUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Liu, ChaoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wahba, RogerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bruns, ChristianeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Brunner, Stefan M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schlitt, Hans J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heumann, AsmusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stueben, Bjoern-OleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Izbicki, Jakob R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bednarsch, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gringeri, EnricoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fasolo, ElisaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rolinger, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kristek, JakubUNSPECIFIEDorcid.org/0000-0002-3758-2273UNSPECIFIED
Hernandez-Alejandro, RobertoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schnitzbauer, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nuessler, NataschaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schoen, Michael R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Voskanyan, SergeyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Petrou, Athanasios S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hahn, OszkarUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Soejima, YujiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vicente, EmilioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Castro-Benitez, CarlosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Adam, ReneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tomassini, FedericoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Troisi, Roberto IvanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kantas, AlexandrosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Oldhafer, Karl JuergenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ardiles, VictoriaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
de Santibanes, EduardoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Malago, MassimoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Clavien, Pierre-AlainUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vivarelli, MarcoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Settmacher, UtzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Aldrighetti, LucaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neumann, UlfUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Petrowsky, HenrikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cillo, UmbertoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lang, HaukeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nadalin, SilvioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-347987
DOI: 10.1245/s10434-019-08192-z
Journal or Publication Title: Ann. Surg. Oncol.
Volume: 27
Number: 5
Page Range: S. 1372 - 1385
Date: 2020
Publisher: SPRINGER
Place of Publication: NEW YORK
ISSN: 1534-4681
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
PORTAL-VEIN LIGATION; ASSOCIATING LIVER PARTITION; STAGED HEPATECTOMY ALPPS; HEPATOBILIARY SCINTIGRAPHY; HEPATIC RESECTION; REMNANT LIVER; SURVIVAL; VOLUME; RECURRENCE; GUIDELINESMultiple languages
Oncology; SurgeryMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/34798

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