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.

1st Department of Surgery Semmelweis University Budapest Hungary

Center for Surgery and Transplantology A 1 Burnazyan Russian State Scientific Center FMBC of FMBA Moscow Russia

Centre Hépato Biliaire AP HP Hôpital Paul Brousse Inserm U 935 Univ Paris Saclay Villejuif France

Clara Campal Oncological Center Sanchinarro University Hospital San Pablo University CEU Madrid Spain

Department of Anatomy 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Clinical Medicine and Surgery Federico 2 University Naples Italy

Department of General Surgery Nicosia Teaching Hospital Strovolos Cyprus

Department of General Visceral and endocrine Surgery München Klinik Neuperlach Munich Germany

Department of General Visceral and Pediatric Surgery University Hospital Düsseldorf Düsseldorf Germany

Department of General Visceral and Thoracic Surgery University Medical Center Hamburg Eppendorf Hamburg Germany

Department of General Visceral and Transplantation Surgery University Hospital Frankfurt Frankfurt Germany

Department of General Visceral and Transplantation Surgery University Hospital Mainz Mainz Germany

Department of General Visceral and Transplantation Surgery University Hospital Tuebingen Tübingen Germany

Department of General Visceral and Vascular Surgery University Hospital Jena Jena Germany

Department of General Visceral Cancer and Transplantation Surgery University Hospital of Cologne Cologne Germany

Department of Hepato Pancreato Biliary Surgery Sun Yat Sen Memorial Hospital Sun Yat Sen University Guangzhou China

Department of Human Structure and Repair Faculty of Medicine Ghent University Ghent Belgium

Department of Public Health Federico 2 University Hospital Naples Italy

Department of Surgery and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden

Department of Surgery and Transplantation São Lucas Hospital Copacabana Rio de Janeiro Brazil

Department of Surgery and Transplantation University Hospital RWTH Aachen Aachen Germany

Department of Surgery Ankara University Ankara Turkey

Department of Surgery Division of HPB Surgery Asklepios Hospital Barmbek Semmelweis University Budapest Campus Hamburg Hamburg Germany

Department of Surgery Federal University of Rio de Janeiro Rio de Janeiro Brazil

Department of Surgery Shinshu University School of Medicine Matsumoto Japan

Department of Surgery University College London London UK

Department of Surgery University Medical Center Regensburg Regensburg Germany

Department of Surgery Virgen de la Arrixaca Hospital IMIB Arrixaca Murcia Spain

Department of Transplant Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic

Division of Transplantation and Hepatobiliary Surgery University of Rochester Rochester NY USA

Hepatobiliary and Abdominal Transplantation Surgery Department of Experimental and Clinical Medicine Polytechnic University of Marche Ancona Italy

Hepatobiliary Surgery and Liver Transplant Unit University of Padua Padua Italy

Hepatobiliary Surgery Division San Raffaele Hospital Milan Italy

HPB Surgery and Liver Transplant Unit Italian Hospital Buenos Aires Buenos Aires Argentina

Klinikum Karlsruhe Karlsruhe Germany

Swiss HPB and Transplantation Center Department of Surgery and Transplantation University Hospital Zurich Zurich Switzerland

Hepatobiliary Pancreat Dis Int. 2022 Dec;21(6):590-593. doi: 10.1016/j.hbpd.2022.05.004. PubMed

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