ALPPS combined with portal vein resection and reconstruction for intrahepatic cholangiocarcinoma

Abstract

Objective To evaluate the safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with portal vein resection and reconstruction in the treatment of intrahepatic cholangiocarcinoma (ICC). Methods A 64-year-old female patient was admitted to our hospital due to intrahepatic bile duct dilatation for 1 week found by physical examination. She was initially diagnosed with ICC in the right lobe complicated with bile duct dilatation. The informed consent of the patient was obtained and the local ethical committee approval was received. The ICGR15 was 0.031. Preoperatively, the volume of future liver remnant (FLR) of left lobe was predicted as 325 ml, accounting for 36.1% of the standard liver volume. ALPPS was performed after comprehensive evaluation. During the first-stage operation, left branch of portal vein was found invaded, the invaded portal vein wall was excised and reshaped, and the portal vein trunk and the left branch were end-to-end anastomosed. The liver parenchyma of right lobe was resected and the right branch of portal vein was resected and closed. Cholangiojejunostomy was performed simultaneously. Right hemihepatectomy combined with right caudate lobectomy was performed at 15 d after the first-stage operation. Results The first-stage operation time was 780 min and the intraoperative blood loss was 600 ml without intraoperative blood transfusion. Fever and bile leakage occurred after operation, which were mitigated after anti-infection and drainage. At postoperative 15 d, the left lobe volume increased to 492 ml, accounting for 54.8% of the standard liver volume. The second-stage operation time was 270 min, the intraoperative blood loss was 700 ml and 4 U red blood cells were infused. Postoperative complications, such as fever, hyponatremia and ascites, were observed, which were healed after symptomatic treatments. CT scan at postoperative 15 d demonstrated that FLR further increased to 624 ml, accounting for 69.5% of the standard liver volume. During postoperative follow-up until February 26, 2019, no signs of recurrence or metastasis were observed. Conclusions ALPPS combined with portal vein resection and reconstruction can offer an opportunity of R0 resection for partial ICC patients with portal vein invasion. It should be strict in choosing appropriate patients, and accurate preoperative evaluation and perioperative management should be delivered to guarantee the perioperative safety. Key words: Bile duct neoplasms; Hepatectomy; Portal vein