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Multicenter Study
. 2017 May;19(5):381-387.
doi: 10.1016/j.hpb.2016.10.008. Epub 2017 Mar 6.

High mortality after ALPPS for perihilar cholangiocarcinoma: case-control analysis including the first series from the international ALPPS registry

Pim B Olthof  1 , Robert J S Coelen  2 , Jimme K Wiggers  2 , Bas Groot Koerkamp  3 , Massimo Malago  4 , Roberto Hernandez-Alejandro  5 , Stefan A Topp  6 , Marco Vivarelli  7 , Luca A Aldrighetti  8 , Ricardo Robles Campos  9 , Karl J Oldhafer  10 , William R Jarnagin  11 , Thomas M van Gulik  2
Affiliations
Multicenter Study

High mortality after ALPPS for perihilar cholangiocarcinoma: case-control analysis including the first series from the international ALPPS registry

Pim B Olthof et al. HPB (Oxford). 2017 May.

Abstract

Introduction: Resection of perihilar cholangiocarcinoma (PHC) entails high-risk surgery with postoperative mortality reported up to 18%, even in specialized centers. The aim of this study was to compare outcomes of PHC patients who underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to patients who underwent resection without ALPPS.

Methods: All patients who underwent ALPPS for PHC were identified from the international ALPPS registry and matched controls were selected from a standard resection cohort from two centers based on future remnant liver size. Outcomes included morbidity, mortality, and overall survival.

Results: ALPPS for PHC was associated with 48% (14/29) 90-day mortality. 90-day mortality was 13% in 257 patients who underwent major liver resection for PHC without ALPPS. The 29 ALPPS patients were matched to 29 patients resected without ALPPS, with similar future liver remnant volume (P = 0.480). Mortality in the matched control group was 24% (P = 0.100) and median OS was 27 months, comparted to 6 months after ALPPS (P = 0.064).

Discussion: Outcomes of ALPPS for PHC appear inferior compared to standard extended resections in high-risk patients. Therefore, portal vein embolization should remain the preferred method to increase future remnant liver volume in patients with PHC. ALPPS is not recommended for PHC.

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Figures

Figure 1
Figure 1
A: Future remnant liver volume before stage one and before stage two of all ALPPS patients in whom both volumes were available (n=23). B: Future remnant liver volume share before stage one of ALPPS patients (n=17) and before standard resection (n=29) and standardized future remnant liver volume share in ALPPS patients before stage one (n=26) and before resection without ALPPS (n=29). C: Overall survival in the selected high risk controls who underwent standard resection of PHC black curve) and ALPPS patients (grey curve). D: Overall survival following exclusion of 90-day mortality.
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