Role of A.L.P.P.S. in treatment of perihilar cholangiocarcinoma: experience of single centre

Abstract

Background: We reported results of a mono-centric experience in the treatment of perihilar cholangiocarcinoma (PHCC) by Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS). Methods: Since January 2013, 16 patients with primary or secondary tumors of the liver and biliary tract, whose future liver remnant (FLR) was considered too small to allow for a liver resection, were evaluated prospectively for ALPPS procedure. Procedure was completed in 13 patients. The indication for surgical resection was PHCC in 4 cases (30.8%). Results: The increase of the FLR between the two procedures was 80 ± 31% (p <0.001). By comparing the results of 4 patients underwent ALPPS for PHCC than the other 9 (No PHCC) emerge the following data: the average time between the first and second phase of the procedure was 8 ± 2 ( PHCC) vs 11.7 ± 2 days (No PHCC); The overall postoperative mortality was 7.69% with only 1 death from liver failure in a patient with PHCC and concomitant liver fibrosis, 25% (PHCC) vs 0% (No PHCC); The overall postoperative morbidity rate was 75% in PHCC patients vs 77.7% (No PHCC). Overall survival was 75% at 6, 12, 24, 30 months (PHCC) vs 100% in 6-12 months, 85% at 12, 24, 30 months (No PHCC). The recurrence-free survival was 100% in 6-12, 24, 30 months (PHCC) vs 100% at 6 months, 87.5% at 12 months, 75% at 24, 30 months (No PHCC). Conclusion: The ALPPS technique has effectively increased the resection of liver tumors otherwise inoperable as PHCC.