Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a two-stage procedure that can potentially cure patients with large cholangiocarcinoma. The current study evaluates the impact of modifications on the outcomes of ALPPS in patients with cholangiocarcinoma. In this single-center study, a series of 30 consecutive patients with cholangiocarcinoma (22 extrahepatic and 8 intrahepatic) who underwent ALPPS between 2011 and 2021 was evaluated. The ALPPS procedure in our center was modified in 2016 by minimizing the first stage of the surgical procedure through biliary externalization after the first stage, antibiotic administration during the interstage phase, and performing biliary reconstructions during the second stage. The rate of postoperative major morbidity and 90-day mortality, as well as the one- and three-year disease-free and overall survival rates were calculated and compared between patients operated before and after 2016. The ALPPS risk score before the second stage of the procedure was lower in patients who were operated on after 2016 (before 2016: median 6.4; after 2016: median 4.4;p= 0.010). Major morbidity decreased from 42.9% before 2016 to 31.3% after 2016, and the 90-day mortality rate decreased from 35.7% before 2016 to 12.5% after 2016. The three-year survival rate increased from 40.8% before 2016 to 73.4% after 2016. Our modified ALPPS procedure improved perioperative and postoperative outcomes in patients with extrahepatic and intrahepatic cholangiocarcinoma. Minimizing the first step of the ALPPS procedure was key to these improvements.
联合肝脏分割和门静脉结扎的分阶段肝切除术（ALPPS）是一种两阶段手术，有望治愈大型胆管癌患者。本研究评估了ALPPS术式改良对胆管癌患者治疗效果的影响。在这项单中心研究中，我们评估了2011年至2021年间连续接受ALPPS手术的30例胆管癌患者（22例肝外胆管癌，8例肝内胆管癌）。本中心于2016年对ALPPS术式进行了改良，具体措施包括：通过第一阶段术后胆道外引流简化第一阶段手术操作、在手术间歇期使用抗生素、并在第二阶段进行胆道重建。我们计算并比较了2016年前后手术患者的术后主要并发症发生率、90天死亡率，以及一年和三年无病生存率与总生存率。2016年后接受手术的患者在ALPPS第二阶段前的风险评分较低（2016年前：中位数6.4；2016年后：中位数4.4；p=0.010）。主要并发症发生率从2016年前的42.9%降至2016年后的31.3%，90天死亡率从35.7%降至12.5%。三年生存率从40.8%提高至73.4%。我们改良的ALPPS术式改善了肝内外胆管癌患者的围手术期及术后结局，其中简化ALPPS第一阶段手术操作是实现这些改善的关键因素。
Promising Outcomes of Modified ALPPS for Staged Hepatectomy in Cholangiocarcinoma
肿瘤(癌症)患者之家