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ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-center Study.
- Source :
-
Annals of surgical oncology [Ann Surg Oncol] 2020 May; Vol. 27 (5), pp. 1372-1384. Date of Electronic Publication: 2020 Jan 30. - Publication Year :
- 2020
-
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).<br />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.<br />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.<br />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.
- Subjects :
- Adult
Aged
Aged, 80 and over
Antineoplastic Agents therapeutic use
Ascites epidemiology
Female
Humans
International Cooperation
Ligation
Male
Middle Aged
Palliative Care
Postoperative Complications epidemiology
Postoperative Hemorrhage epidemiology
Propensity Score
Proportional Hazards Models
Registries
SEER Program
Surgical Wound Infection epidemiology
Survival Rate
Treatment Outcome
Bile Duct Neoplasms surgery
Bile Ducts, Intrahepatic
Cholangiocarcinoma surgery
Hepatectomy methods
Liver Failure prevention & control
Portal Vein surgery
Postoperative Complications prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1534-4681
- Volume :
- 27
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Annals of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 32002719
- Full Text :
- https://doi.org/10.1245/s10434-019-08192-z