Background: ALPPS popularity is increasing among surgeons worldwide and its indications are expanding to cure patients with primarily unresectable liver tumors. Few reports recommended limitations or even contraindications of ALPPS in perihilar cholangiocarcinoma (phCC). Here, we discuss the results of ALPPS in patients with phCC in a systematic review as well as a pooled data analysis. Methods: MEDLINE and Web of Science databases were systematically searched for relevant literature up to December 2023. All studies reporting ALPPS in the management of phCC were included. A single-arm meta-analysis of proportions was carried out to estimate the overall rate of outcomes. Results: After obtaining 207 articles from the primary search, data of 18 studies containing 112 phCC patients were included in our systematic review. Rates of major morbidity and mortality were calculated to be 43% and 22%, respectively. The meta-analysis revealed a PHLF rate of 23%. One-year disease-free survival was 65% and one-year overall survival was 69%. Conclusions: ALPPS provides a good chance of cure for patients with phCC in comparison to alternative treatment options, but at the expense of debatable morbidity and mortality. With refinement of the surgical technique and better perioperative patient management, the results of ALPPS in patients with phCC were improved.
背景：联合肝脏离断和门静脉结扎的二步肝切除术（ALPPS）在全球外科医生中的普及度日益增加，其适应症正扩展至治疗初始不可切除的肝脏肿瘤。目前鲜有报告提出ALPPS在肝门部胆管癌（phCC）治疗中的限制甚至禁忌症。本文通过系统综述及汇总数据分析，探讨ALPPS在phCC患者中的应用效果。 方法：系统检索截至2023年12月MEDLINE和Web of Science数据库中相关文献，纳入所有报道ALPPS治疗phCC的研究。采用单组比例荟萃分析评估总体结局发生率。 结果：经初步检索获得207篇文献后，共纳入18项研究（包含112例phCC患者）数据。主要并发症发生率和死亡率分别为43%和22%。荟萃分析显示肝切除术后肝衰竭发生率为23%。一年无病生存率为65%，一年总生存率为69%。 结论：相较于其他治疗方案，ALPPS为phCC患者提供了良好的治愈机会，但需承担值得商榷的并发症与死亡风险。随着手术技术的改进及围手术期患者管理的优化，ALPPS在phCC患者中的治疗效果已得到提升。
肿瘤(癌症)患者之家