A Comparative Retrospective Study of in Situ Split Plus Portal Vein Ligation (ISLT) Versus Conventional Two-Stage Hepatectomy for Cholangiocellular Carcinoma - Does the ISLT Procedure Have an Oncological Advantage?

Abstract

Introduction: Cholangiocellular carcinoma (CCA) has a poor prognosis and the mainstay of therapy even in locally advanced cases remains radical surgical resection. This approach however is limited by the future liver remnant (FLR) volume after extensive parenchymal dissection leading to postoperative liver failure and high mortality rates. The aim of this study was to compare the outcome of in situ liver transection with portal vein ligation (ISLT) procedure and conventional two-stage hepatectomy with portal vein embolization (PVE/TSH) in patients with CCA. Methods: All patients with CCA and insufficient FLR considered for either ISLT or PVE/TSH were analyzed for outcomes including postoperative morbidity and mortality as well as overall survival rates (OS). Results: Of the total 24 patients included, 16 patients received ISLT. The remaining 8 patients underwent PVE/TSH. The completion rate of the second stage in the PVE/TSH group was 62% and 100% in the ISLT group (p=0.027). The overall 90-days-morbidity was comparable (PVE/TSH 40% vs. ISLT 69%, p=0.262). OS at follow-up (median: 7 months) did not significantly differ between the two groups (p>0.05). In multivariate analysis, biliary resection and reconstruction was the only risk factor independently associated with significantly higher morbidity and mortality rates (HR=23.33; 95%CI (1.99-273.29); p=0.012). Conclusion: Our results demonstrate comparable outcomes in both groups in a rather prognostically unfavourable disease. The completion rate in the ISLT group was significantly higher than in the PVE/TSH cohort. This work encourages specialized HPB centers in applying the ISLT procedure in selected cases with cholangiocellular carcinoma.