Promising Results of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy for Perihilar Cholangiocarcinoma in a Systematic Review and Single-Arm Meta-Analysis.

Simple Summary: The increasing popularity of ALPPS (Associating Liver Partition and Portal vein Ligation for Staged hepatectomy) in treating unresectable liver tumors has extended to perihilar cholangiocarcinoma (phCC), despite some reservations about its use in these cases. This systematic review and pooled data analysis, which included 112 phCC patients from 18 studies, was based on the literature from MEDLINE and Web of Science up to December 2023. The findings showed significant rates of major morbidity (43%) and mortality (22%), with a post-hepatectomy liver failure (PHLF) rate of 23%. However, promising one-year disease-free and overall survival rates were observed at 65% and 69%, respectively. This study concludes that ALPPS offers a viable treatment option for phCC, potentially superior to alternatives, although it is associated with considerable risks. Improvements in surgical techniques and perioperative management could further enhance its efficacy and safety. Background: ALPPS popularity is increasing among surgeons worldwide and its indications are expanding to cure patients with primarily unresectable liver tumors. Few reports recommended limitations or even contraindications of ALPPS in perihilar cholangiocarcinoma (phCC). Here, we discuss the results of ALPPS in patients with phCC in a systematic review as well as a pooled data analysis. Methods: MEDLINE and Web of Science databases were systematically searched for relevant literature up to December 2023. All studies reporting ALPPS in the management of phCC were included. A single-arm meta-analysis of proportions was carried out to estimate the overall rate of outcomes. Results: After obtaining 207 articles from the primary search, data of 18 studies containing 112 phCC patients were included in our systematic review. Rates of major morbidity and mortality were calculated to be 43% and 22%, respectively. The meta-analysis revealed a PHLF rate of 23%. One-year disease-free survival was 65% and one-year overall survival was 69%. Conclusions: ALPPS provides a good chance of cure for patients with phCC in comparison to alternative treatment options, but at the expense of debatable morbidity and mortality. With refinement of the surgical technique and better perioperative patient management, the results of ALPPS in patients with phCC were improved. [ABSTRACT FROM AUTHOR]