Safety and efficacy of RALPPS in cholangiocarcinoma patients

Abstract

Objective: Estimation of the short-term results of split-in-situ resection with radio-frequency ablation (RFA) instead of liver partition on the first stage (RALPPS) in patients with hilar (h-CCA) and intrahepatic (i-CCA) cholangiocarcinoma compared with portal vein embolization (PVE). Summary background data: Unsatisfactory immediate outcomes of Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in surgery of cholangiocarcinoma suggested that patients with biliary cancer should not be treated by ALPPS. Short-term results of ALPPS variants with reduced surgical trauma on the first stage in patients with cholangiocarcinoma were not yet estimated. Methods: RALPPS and PVE were applied in 10 and 18 patients respectively. Future liver remnant (FLR) was estimated by CT. The propensity score matching method was used in compared groups. Results: The mean rate of FLR hypertrophy after RALPPS/PVE before and after matching was 42%/32% and 49%/31%, respectively. The mean duration of hypertrophy after RALPPS/PVE before and after matching was 16/20 days and 14/17 days, respectively, without significant differences. Major morbidity rate (IIIa grade, Clavien-Dindo) after the stage 1 was significantly larger for RALPPS before matching. There were no differences in morbidity of stage 1 after matching as well as for stage 2 before and after matching. Conclusions: According to preliminary short-term results estimation RALPPS may be considered as an effective and safe minimally invasive variant of ALPPS for rapid FLR hypertrophy in patients with h-CCA and i-CCA. Further prospective studies are needed to confirm discovered benefits of RALPPS in patients with cholangiocarcinoma.