High mortality after ALPPS for perihilar cholangiocarcinoma: case-control analysis including the first series from the international ALPPS registry

PB Olthof, RJS Coelen, JK Wiggers, B Groot Koerkamp, M Malago, R Hernandez-Alejandro, SA Topp, M Vivarelli, LA Aldrighetti, R Robles Campos, KJ Oldhafer, WR Jarnagin, TM van Gulik

Research output: Contribution to journalArticle

Abstract

Introduction Resection of perihilar cholangiocarcinoma (PHC) entails high-risk surgery with postoperative mortality reported up to 18%, even in specialized centers. The aim of this study was to compare outcomes of PHC patients who underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to patients who underwent resection without ALPPS. Methods All patients who underwent ALPPS for PHC were identified from the international ALPPS registry and matched controls were selected from a standard resection cohort from two centers based on future remnant liver size. Outcomes included morbidity, mortality, and overall survival. Results ALPPS for PHC was associated with 48% (14/29) 90-day mortality. 90-day mortality was 13% in 257 patients who underwent major liver resection for PHC without ALPPS. The 29 ALPPS patients were matched to 29 patients resected without ALPPS, with similar future liver remnant volume (P = 0.480). Mortality in the matched control group was 24% (P = 0.100) and median OS was 27 months, comparted to 6 months after ALPPS (P = 0.064). Discussion Outcomes of ALPPS for PHC appear inferior compared to standard extended resections in high-risk patients. Therefore, portal vein embolization should remain the preferred method to increase future remnant liver volume in patients with PHC. ALPPS is not recommended for PHC. © 2016
Original languageEnglish
Pages (from-to)381-387
Number of pages7
JournalHPB
Volume19
Issue number5
DOIs
Publication statusPublished - 2017

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    Olthof, PB., Coelen, RJS., Wiggers, JK., Groot Koerkamp, B., Malago, M., Hernandez-Alejandro, R., Topp, SA., Vivarelli, M., Aldrighetti, LA., Robles Campos, R., Oldhafer, KJ., Jarnagin, WR., & van Gulik, TM. (2017). High mortality after ALPPS for perihilar cholangiocarcinoma: case-control analysis including the first series from the international ALPPS registry. HPB, 19(5), 381-387. https://doi.org/10.1016/j.hpb.2016.10.008