Department of Surgery, Ankara University School of Medicine, Ankara, Turkey.
Department of Radiology, Ankara University School of Medicine, Ankara, Turkey.
J Surg Oncol. 2020 May;121(6):1022-1026. doi: 10.1002/jso.25868. Epub 2020 Feb 18.
The treatment for perihilar cholangiocarcinoma (PHC) is a challenge for the surgeon requiring complex resections with a reported perioperative mortality rate between 15% and 48%. In PHC patients with future liver remnant (FLR) less than 30%, it is advised that hepatectomy can be safely performed after the FLR is modified. Associating Liver Partition and Portal vein ligation for Staged Hepatectomy (ALPPS) procedure is criticized heavily due to its high morbidity and mortality rate in this setting. Hereby, we are reporting a modification of ALPPS procedure for PHC. Clinical presentation, preoperative work-up as well as operation and postoperative course of two cases were described in detail. Both patients were jaundiced preoperatively, stage 1 partial-ALPPS procedures were performed laparoscopically, there was sufficient remnant hypertrophy during the interval stage and there was no posthepatectomy liver failure after the second stage (Supporting Information Video). We have followed patients with a mean follow up of 35 months without any recurrence. Here we describe the key technical aspects of this approach that are discussed in three parts: minimally invasive first stage, biliary drainage of both FLR, and deportalized liver at first stage and biliary reconstruction at the second stage. This technique, in selected patients, can extend the indication of ALPPS procedure for PHC with preoperative jaundice.
肝门部胆管癌（PHC）的治疗对外科医生来说是一个挑战，需要进行复杂的切除术，其围手术期死亡率报告在 15%至 48%之间。对于未来肝残留量（FLR）小于 30%的 PHC 患者，建议在 FLR 得到修正后，可以安全地进行肝切除术。由于在这种情况下，联合肝脏分隔和门静脉结扎的分期肝切除术（ALPPS）的高发病率和死亡率，该手术受到了强烈的批评。在此，我们报告了一种用于 PHC 的 ALPPS 手术改良方法。详细描述了两例患者的临床表现、术前检查以及手术和术后过程。两名患者术前均有黄疸，行腹腔镜分期 1 部分-ALPPS 手术，间隔期有足够的残肝肥大，第二期后无肝切除术后肝功能衰竭（支持信息视频）。我们对这些患者进行了平均 35 个月的随访，没有任何复发。在这里，我们描述了这种方法的关键技术方面，这些方面分为三个部分讨论：第一阶段的微创、FLR 的双胆管引流以及第一阶段的门静脉肝切除术和第二阶段的胆管重建。在选定的患者中，这种技术可以将术前黄疸的 PHC 的 ALPPS 手术适应证扩大。
