The role of ALPPS in intrahepatic cholangiocarcinoma

Bednarsch, Jan; Czigány, Zoltán; Lurje, Isabella; Strnad, Pavel; Bruners, Philipp; Ulmer, Tom Florian; Dulk, Marcel den; Lurje, Georg; Neumann, Ulf

doi:10.1007/s00423-019-01838-2

Cited by 22 publications

(29 citation statements)

References 40 publications

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“…All patients underwent a detailed clinical work-up as previously described [14,15]. In brief, this included a suitable oncological staging by cross-sectional imaging, e.g., contrast-enhanced multiphase computed tomography (CT) and/or dynamic magnetic resonance imaging (MRI) of the liver to visualize metastatic pattern and the relationship of metastases to major anatomic structures.…”

Section: Clinical Management and Surgical Techniquementioning

confidence: 99%

“…ALPPS and TSH/PVE were considered in cases requiring extended liver resections with an estimated FLR of less than 30% in single-step surgery as previously described [14]. Both procedures were also considered in cases with complex oncological situations (e.g., resection of the primary with concomitant "clean up" of one liver lobe) or distinct metastatic patterns which required two-step surgery to safely resect all metastases.…”

Section: Clinical Management and Surgical Techniquementioning

confidence: 99%

“…ALPPS was performed according to the recommendations of the latest international consensus conference and as previously described [5,14]. Briefly, the liver parenchyma was fully or partially transected during stage I using the Cavitron Ultrasonic Surgical Aspirator (CUSA) and intermittent Pringle maneuvers if necessary.…”

Section: Clinical Management and Surgical Techniquementioning

confidence: 99%

“…Volume growth and functional recovery of the liver were ensured by an inter-stage CT scan and a liver function monitoring by LiMAx and standard liver function tests before patients were scheduled for stage II surgery. Here, the hepatectomy was completed [14].…”

Section: Clinical Management and Surgical Techniquementioning

confidence: 99%

“…TV was considered as nonfunctional liver parenchyma for all calculations. Finally, the calculated FLR (cFLR) was computed by the following formula: [14].…”

Section: Volumetric Analysismentioning

confidence: 99%

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ALPPS versus two-stage hepatectomy for colorectal liver metastases—–a comparative retrospective cohort study

et al. 2020

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Background: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and two stage hepatectomy with inter-stage portal vein embolization (TSH/PVE) are surgical maneuvers applied in patients with advanced malignancies considered unresectable by means of conventional liver surgery. The aim of this report is to compare the oncologic outcome and technical feasibility of ALPPS and TSH/PVE in the scenario of colorectal liver metastases (CRLM). Methods: All consecutive patients who underwent either ALPPS or TSH/PVE for CRLM between 2011 and 2017 in one hepatobiliary center were analyzed and compared regarding perioperative and long-term oncologic outcome. Results: A cohort of 58 patients who underwent ALPPS (n = 21) or TSH/PVE (n = 37) was analyzed. The median overall survival (OS) was 28 months and 34 months after ALPPS and TSH/PVE (p = 0.963), respectively. The median recurrence-free survival (RFS) was higher following ALPPS with 19 months than following TSH/PVE with 10 months, but marginally failed to achieve statistical significance (p = 0.05). There were no differences in morbidity and mortality after stages 1 and 2. Patients undergoing ALPPS due to insufficient hypertrophy after TSH/PVE (rescue-ALPPS) displayed similar oncologic outcome as patients treated by conventional ALPPS or TSH/PVE (p = 0.971). Conclusions: ALPPS and TSH/PVE show excellent technical feasibility and comparable long-term oncologic outcome in CRLM. Rescue ALPPS appears to be a viable option for patients displaying insufficient hypertrophy after a TSH/PVE approach.

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Section: Clinical Management and Surgical Techniquementioning

confidence: 99%

Section: Clinical Management and Surgical Techniquementioning

confidence: 99%

Section: Clinical Management and Surgical Techniquementioning

confidence: 99%

Section: Clinical Management and Surgical Techniquementioning

confidence: 99%

“…TV was considered as nonfunctional liver parenchyma for all calculations. Finally, the calculated FLR (cFLR) was computed by the following formula: [14].…”

Section: Volumetric Analysismentioning

confidence: 99%

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ALPPS versus two-stage hepatectomy for colorectal liver metastases—–a comparative retrospective cohort study

et al. 2020

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The prognostic impact of preoperative body composition in perihilar and intrahepatic cholangiocarcinoma

et al. 2022

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Cholangiocarcinoma (CCA) is a rare but highly aggressive malignancy of the biliary system. Although it is amenable to surgical resection in early disease, outcomes are frequently dismal. Here, we investigated the prevalence of body composition (BC) alterations and their prognostic role for surgical patients with intrahepatic (iCCA) and perihilar (pCCA) disease. Patients undergoing curative‐intent surgery for iCCA or pCCA between 2010 and 2019 at University Hospital Aachen were included. Axial computed tomography images were retrospectively assessed with a segmentation tool (3D Slicer) at the level of the third lumbar vertebra to determine lumbar skeletal muscle (SM) index, mean SM radiation attenuation, and visceral fat area. The related BC pathologies sarcopenia, myosteatosis, visceral obesity, and sarcopenic obesity were determined using previously described cutoffs. A total of 189 patients (86 with iCCA, 103 with pCCA) were included. Alterations of BC were highly prevalent in iCCA and pCCA, respectively: sarcopenia, 33% (28/86) and 39% (40/103); myosteatosis, 66% (57/86) and 66% (68/103); visceral obesity, 56% (48/86) and 67% (69/103); sarcopenic obesity, 11% (9/86) and 17% (17/103). Sarcopenia and myosteatosis did not have a significant prognostic role for disease‐free survival (DFS) and overall survival (OS). Patients with iCCA with sarcopenic obesity (n = 9) had significantly shorter OS than patients without sarcopenic obesity (n = 7; log‐rank p = 0.002; median OS, 11 months and 31 months; 1‐year mortality, 55.6% [5/9] and 22% [17/77]; 5‐year mortality, 88.9% [8/9] and 61% [47/77], respectively). In multivariable analysis, only tumor‐related risk factors remained prognostic for DFS and OS. Sarcopenic obesity may affect clinical outcomes after curative‐intent surgery for iCCA, indicating that imaging‐based analysis of BC may hold prognostic value for long‐term survival and could aid preoperative patient selection.

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Surgical Treatment of Intrahepatic Cholangiocarcinoma

Kim,

Park

2021

Hepato-Pancreato-Biliary Malignancies

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The role of ALPPS in intrahepatic cholangiocarcinoma

Cited by 22 publications

References 40 publications

ALPPS versus two-stage hepatectomy for colorectal liver metastases—–a comparative retrospective cohort study

ALPPS versus two-stage hepatectomy for colorectal liver metastases—–a comparative retrospective cohort study

The prognostic impact of preoperative body composition in perihilar and intrahepatic cholangiocarcinoma

Surgical Treatment of Intrahepatic Cholangiocarcinoma

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