Is there still a place for cholangiocarcinoma in the ALPPS?

Abstract

Background: Although the first case of ALPPS was successfully performed in a patient with phCCA, due to the high morbility and mortality CCA is often considered a relative contraindication to ALPPS. Methods: We retrospectively analyzed our single center experience on the use of ALPPS for Cholangiocarcinoma focusing on postoperative complications, patient survival and tumor recurrence. Results: Between November 2010 and November 2016 we performed 21 ALPPS for suspected cholangiocarcinoma (6 phCCA, 11 iCCA, 2 Gallbladder carcinoma (GBCA) and 2 Klatskin-mimicking IPN) with a feasibility of 100%. Median age was 70 years. BDA was performed in 17 patients (5 phCCA, 9 iCCA, 2 GBCA and 1 IPN). T-Tube was used in 1 iCCA and 1 GBCA at Stage 1. A R0 status was reached in 15 patients (4 phCCA, 7 iCCA, 2 GBCA, 2 IPN). Morbidity was 100% for phCCA, 82% for iCCA, 100% for GBCA, 33% for IPN. The postoperative mortality rate was 50% for phCCA, 18% iCCA, 0% GBCA and IPN. ASA-Score 3, preoperative stent, Liver fibrosis, PHLF≥B after Stage 2 were identified as independent risk factors for postoperative mortality. The overall disease-free survival at 1 year was 67% for phCCA, 43% for iCCA. 1 iCCA died after recurrence. The 3y OS was 50% for phCCA and 67% for iCCA, but excluding the postoperative death was 100% for phCCA and 90% for iCCA. Conclusion: Despite a high morbidity, with a precise patient selection mortality can be avoided and ALPPS can be used with intention to treat also for cholangiocarcinoma.