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články
články
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Source: BMČ - články
Title
ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-center Study / J. Li, M. Moustafa, M. Linecker, G. Lurje, I. Capobianco, J. Baumgart, F. Ratti, F. Rauchfuss, D. Balci, E. Fernandes, R. Montalti, R. Robles-Campos, B. Bjornsson, SA. Topp, J. Fronek, C. Liu, R. Wahba, C. Bruns, SM. Brunner, HJ. Schlitt, A. Heumann, BO. Stüben, JR. Izbicki, J. Bednarsch, E. Gringeri, E. Fasolo, J. Rolinger, J. Kristek, R. Hernandez-Alejandro, A. Schnitzbauer, N. Nuessler, MR. Sch
Author
Li, Jun
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. j.li@uke.de.

Moustafa, Mohamed
Hepatobiliary Surgery and Liver Transplant Unit, University of Padua, Padua, Italy.

Linecker, Michael
Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.

Lurje, Georg
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.

Capobianco, Ivan
Department of General, Visceral and Transplantation Surgery, University Hospital Tuebingen, Tübingen, Germany.

Baumgart, Janine
Department of General, Visceral and Transplantation Surgery, University Hospital Mainz, Mainz, Germany.

Ratti, Francesca
Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy.

Rauchfuss, Falk
Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany.

Balci, Deniz
Department of Surgery, Ankara University, Ankara, Turkey.

Fernandes, Eduardo
Department of Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. Department of Surgery and Transplantation, São Lucas Hospital - Copacabana, Rio de Janeiro, Brazil.

Montalti, Roberto
Department of Public Health, Federico II University Hospital, Naples, Italy.

Robles-Campos, Ricardo
Department of Surgery, Virgen de la Arrixaca Hospital, IMIB-Arrixaca, Murcia, Spain.

Bjornsson, Bergthor
Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.

Topp, Stefan A
Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Düsseldorf, Germany.

Fronek, Jiri
Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.

Liu, Chao
Department of Hepato-Pancreato-Biliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.

Wahba, Roger
Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany.

Bruns, Christiane
Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany.

Brunner, Stefan M
Department of Surgery, University Medical Center Regensburg, Regensburg, Germany.

Schlitt, Hans J
Department of Surgery, University Medical Center Regensburg, Regensburg, Germany.

Heumann, Asmus
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Stüben, Björn-Ole
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Izbicki, Jakob R
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Bednarsch, Jan
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.

Gringeri, Enrico
Hepatobiliary Surgery and Liver Transplant Unit, University of Padua, Padua, Italy.

Fasolo, Elisa
Hepatobiliary Surgery and Liver Transplant Unit, University of Padua, Padua, Italy.

Rolinger, Jens
Department of General, Visceral and Transplantation Surgery, University Hospital Tuebingen, Tübingen, Germany.

Kristek, Jakub
Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.

Hernandez-Alejandro, Roberto
Division of Transplantation and Hepatobiliary Surgery, University of Rochester, Rochester, NY, USA.

Schnitzbauer, Andreas
Department of General, Visceral and Transplantation Surgery, University Hospital Frankfurt, Frankfurt, Germany.

Nuessler, Natascha
Department of General, Visceral and endocrine Surgery, München Klinik Neuperlach, Munich, Germany.

Schön, Michael R
Klinikum Karlsruhe, Karlsruhe, Germany.

Voskanyan, Sergey
Center for Surgery and Transplantology, A.I. Burnazyan Russian State Scientific Center FMBC of FMBA, Moscow, Russia.

Petrou, Athanasios S
Department of General Surgery, Nicosia Teaching Hospital, Strovolos, Cyprus.

Hahn, Oszkar
1st Department of Surgery, Semmelweis University, Budapest, Hungary.

Soejima, Yuji
Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.

Vicente, Emilio
"Clara Campal" Oncological Center, Sanchinarro University Hospital, San Pablo University. CEU, Madrid, Spain.

Castro-Benitez, Carlos
Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm U 935, Univ Paris-Saclay, Villejuif, France.

Adam, René
Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm U 935, Univ Paris-Saclay, Villejuif, France.

Tomassini, Federico
Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Ghent, Belgium.

Troisi, Roberto Ivan
Department of Human Structure and Repair, Faculty of Medicine, Ghent University, Ghent, Belgium. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.

Kantas, Alexandros
Department of Surgery, Division of HPB Surgery, Asklepios Hospital Barmbek, Semmelweis University Budapest, Campus Hamburg, Hamburg, Germany.

Oldhafer, Karl Juergen
Department of Surgery, Division of HPB Surgery, Asklepios Hospital Barmbek, Semmelweis University Budapest, Campus Hamburg, Hamburg, Germany.

Ardiles, Victoria
HPB Surgery and Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina.

de Santibanes, Eduardo
HPB Surgery and Liver Transplant Unit, Italian Hospital Buenos Aires, Buenos Aires, Argentina.

Malago, Massimo
Department of Surgery, University College London, London, UK.

Clavien, Pierre-Alain
Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.

Vivarelli, Marco
Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.

Settmacher, Utz
Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany.

Aldrighetti, Luca
Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy.

Neumann, Ulf
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.

Cited source
Annals of surgical oncology. 2020, roč. 27, č. 5, s. 1372-1384. ISSN: 1068-9265; 1534-4681 (elektronická verze).
Date of issue
2020
Language
angličtina
Country
Spojené státy americké
Document type
články
DOI
Pubmed ID
Link
Record number
bmc20028188
Persistent link
English Abstract
BACKGROUND: ALPPS is found to increase the resectability of primary and secondary liver malignancy at the advanced stage. The aim of the study was to verify the surgical and oncological outcome of ALPPS for intrahepatic cholangiocarcinoma (ICC). METHODS: The study cohort was based on the ALPPS registry with patients from 31 international centers between August 2009 and January 2018. Propensity score matched patients receiving chemotherapy only were selected from the SEER database as controls for the survival analysis. RESULTS: One hundred and two patients undergoing ALPPS were recruited, 99 completed the second stage with median inter-stage duration of 11 days. The median kinetic growth rate was 23 ml/day. R0 resection was achieved in 87 (85%). Initially high rates of morbidity and mortality decreased steadily to a 29% severe complication rate and 7% 90-day morbidity in the last 2 years. Post-hepatectomy liver failure remained the main cause of 90-day mortality. Multivariate analysis revealed insufficient future liver remnant at the stage-2 operation (FLR2) to be the only risk factor for severe complications (OR 2.91, p = 0.02). The propensity score matching analysis showed a superior overall survival in the ALPPS group compared to palliative chemotherapy (median overall survival: 26.4 months vs 14 months; 1-, 2-, and 3-year survival rates: 82.4%, 70.5% and 39.6% vs 51.2%, 21.4% and 11.3%, respectively, p < 0.01). The survival benefit, however, was not confirmed in the subgroup analysis for patients with insufficient FLR2 or multifocal ICC. CONCLUSION: ALPPS showed high efficacy in achieving R0 resections in locally advanced ICC. To get the most oncological benefit from this aggressive surgery, ALPPS would be restricted to patients with single lesions and sufficient FLR2.
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