Li, Jun and Moustafa, Mohamed and Linecker, Michael and Lurje, Georg and Capobianco, Ivan and Baumgart, Janine and Ratti, Francesca and Rauchfuss, Falk and Balci, Deniz and Fernandes, Eduardo and Montalti, Roberto and Robles-Campos, Ricardo and Bjornsson, Bergthor and Topp, Stefan A. and Fronek, Jiri and Liu, Chao and Wahba, Roger and Bruns, Christiane and Brunner, Stefan M. and Schlitt, Hans J. and Heumann, Asmus and Stueben, Bjoern-Ole and Izbicki, Jakob R. and Bednarsch, Jan and Gringeri, Enrico and Fasolo, Elisa and Rolinger, Jens and Kristek, Jakub and Hernandez-Alejandro, Roberto and Schnitzbauer, Andreas and Nuessler, Natascha and Schoen, Michael R. and Voskanyan, Sergey and Petrou, Athanasios S. and Hahn, Oszkar and Soejima, Yuji and Vicente, Emilio and Castro-Benitez, Carlos and Adam, Rene and Tomassini, Federico and Troisi, Roberto Ivan and Kantas, Alexandros and Oldhafer, Karl Juergen and Ardiles, Victoria and de Santibanes, Eduardo and Malago, Massimo and Clavien, Pierre-Alain and Vivarelli, Marco and Settmacher, Utz and Aldrighetti, Luca and Neumann, Ulf and Petrowsky, Henrik and Cillo, Umberto and 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. ANNALS OF SURGICAL ONCOLOGY, 27 (5). pp. 1372-1384. ISSN 1068-9265, 1534-4681
Full text not available from this repository. (Request a copy)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: | Article |
|---|---|
| Uncontrolled Keywords: | PORTAL-VEIN LIGATION; ASSOCIATING LIVER PARTITION; STAGED HEPATECTOMY ALPPS; HEPATOBILIARY SCINTIGRAPHY; HEPATIC RESECTION; REMNANT LIVER; SURVIVAL; VOLUME; RECURRENCE; GUIDELINES; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 01 Apr 2021 07:52 |
| Last Modified: | 01 Apr 2021 07:52 |
| URI: | https://pred.uni-regensburg.de/id/eprint/45299 |
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