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

TY - JOUR

T1 - ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-center Study

AU - Li, Jun

AU - Moustafa, Mohamed

AU - Linecker, Michael

AU - Lurje, Georg

AU - Capobianco, Ivan

AU - Baumgart, Janine

AU - Ratti, Francesca

AU - Rauchfuss, Falk

AU - Balci, Deniz

AU - Fernandes, Eduardo

AU - Montalti, Roberto

AU - Robles-Campos, Ricardo

AU - Bjornsson, Bergthor

AU - Topp, Stefan A

AU - Fronek, Jiri

AU - Liu, Chao

AU - Wahba, Roger

AU - Bruns, Christiane

AU - Brunner, Stefan M

AU - Schlitt, Hans J

AU - Heumann, Asmus

AU - Stüben, Björn-Ole

AU - Izbicki, Jakob R

AU - Bednarsch, Jan

AU - Gringeri, Enrico

AU - Fasolo, Elisa

AU - Rolinger, Jens

AU - Kristek, Jakub

AU - Hernandez-Alejandro, Roberto

AU - Schnitzbauer, Andreas

AU - Nuessler, Natascha

AU - Schön, Michael R

AU - Voskanyan, Sergey

AU - Petrou, Athanasios S

AU - Hahn, Oszkar

AU - Soejima, Yuji

AU - Vicente, Emilio

AU - Castro-Benitez, Carlos

AU - Adam, René

AU - Tomassini, Federico

AU - Troisi, Roberto Ivan

AU - Kantas, Alexandros

AU - Oldhafer, Karl Juergen

AU - Ardiles, Victoria

AU - de Santibanes, Eduardo

AU - Malago, Massimo

AU - Clavien, Pierre-Alain

AU - Vivarelli, Marco

AU - Settmacher, Utz

AU - Aldrighetti, Luca

AU - Neumann, Ulf

AU - Petrowsky, Henrik

AU - Cillo, Umberto

AU - Lang, Hauke

AU - Nadalin, Silvio

PY - 2020/5

Y1 - 2020/5

N2 - 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.

AB - 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.

U2 - 10.1245/s10434-019-08192-z

DO - 10.1245/s10434-019-08192-z

M3 - SCORING: Journal article

C2 - 32002719

VL - 27

SP - 1372

EP - 1384

JO - ANN SURG ONCOL

JF - ANN SURG ONCOL

SN - 1068-9265

IS - 5

ER -