Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma.

F Oldhafer,S Cammann,M Kleine,W Ramackers,H Bektas,K I Ringe,K Timrott,F W R Vondran,J Klempnauer,M D Jäger

doi:10.1155/2015/273641

Abstract

Background. Surgical resection remains the best treatment option for intrahepatic cholangiocarcinoma (ICC). Two-stage liver resection combining in situ liver transection with portal vein ligation (ALPPS) has been described as a promising method to increase the resectability of liver tumors also in the case of ICC. Presentation of Case. A 46-year-old male patient presented with an ICC-typical lesion in the right liver. The indication for primary liver resection was set and planed as a right hepatectomy. In contrast to the preoperative CT-scan, the known lesion showed further progression in a macroscopically steatotic liver. Therefore, the decision was made to perform an ALPPS-procedure to avoid an insufficient future liver remnant (FLR). The patient showed an uneventful postoperative course after the first and second step of the ALPPS-procedure, with sufficient increase of the FLR. Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan. Discussion. The presented case demonstrates that an intraoperative conversion to an ALPPS-procedure is safely applicable when the FLR surprisingly seems to be insufficient. Conclusion. ALPPS should also be considered a treatment option in well-selected patients with ICC. However, the experience concerning the outcome of ALPPS in case of ICC remains fairly small.

Highlights

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor representing about 10% to 20% of all primary malignant liver tumors [1, 2]
Primary sclerosing cholangitis has been identified as a major risk factor for development of intrahepatic cholangiocarcinoma (ICC) [3, 4]
The patient required no transfusions of packed red blood cells or fresh frozen plasma (FFP) and showed an uneventful postoperative recovery after the first step of the ALPPS-procedure with discharge from the intensive care unit (ICU) within 3 days

Summary

Background

Surgical resection remains the best treatment option for intrahepatic cholangiocarcinoma (ICC). A 46-year-old male patient presented with an ICC-typical lesion in the right liver. In contrast to the preoperative CT-scan, the known lesion showed further progression in a macroscopically steatotic liver. The decision was made to perform an ALPPS-procedure to avoid an insufficient future liver remnant (FLR). The patient showed an uneventful postoperative course after the first and second step of the ALPPS-procedure, with sufficient increase of the FLR. Already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan. The presented case demonstrates that an intraoperative conversion to an ALPPS-procedure is safely applicable when the FLR surprisingly seems to be insufficient. ALPPS should be considered a treatment option in well-selected patients with ICC. The experience concerning the outcome of ALPPS in case of ICC remains fairly small

Introduction

Presentation of Case

Findings

Discussion