PRALPPS in patients with perihilar cholangiocarcinoma. Analysis of short-term outcomes

Abstract

Introduction: Mortality after ALPPS in patients with perihillar cholangiocarcinoma (PHCC) still remains frustrating. We aimed to compare the short-term outcomes of Percutaneous Radio-frequency Assisted Liver Partition with Portal vein embolization in Staged liver resection (PRALPPS) with immediate results of conventional Portal Vein Embolization (PVE) followed by major liver resection in patients with PHCC. Method: Indication for both procedures was the volume of future liver remnant (FLR) <40%. PRALPPS and conventional PVE were compared in terms of morbidity, mortality, and the first stage efficacy which was estimated by kinetic growth rate (KGR), time interval and degree of hypertrophy (DH) of FLR. Result: No 90-day mortality was registered in the whole series. Stage 1/2 were performed in 11/9 and 18/14 patients in PRALPPS and PVE groups, respectively. Major morbidity rate after the stage 1 did not differ between groups. There were no differences in blood loss, severe morbidity and liver failure rate after the stage 2. The mean KGR of FLR after PRALPPS and PVE was 3,8 (0,6-9,8)%/day and 1,8 (0-6,7)%/day, respectively (p=0,039). The mean time interval of FLR hypertrophy in PRALPPS and PVE groups was 15 (6-29) days and 20 (8-35) days, respectively (p=0,039). Conclusion: PRALPPS may be considered as effective and safe modified variant of ALPPS for hypertrophy of the FLR in patients with perihilar cholangiocarcinoma.