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在一项系统评价和单臂荟萃分析中，肝门部胆管癌分期肝切除联合肝分割和门静脉结扎术的良好结果。

Promising Results of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy for Perihilar Cholangiocarcinoma in a Systematic Review and Single-Arm Meta-Analysis.

作者信息

Golriz Mohammad, Ramouz Ali, Hammad Ahmed, Aminizadeh Ehsan, Sabetkish Nastaran, Khajeh Elias, Ghamarnejad Omid, Carvalho Carlos, Rio-Tinto Hugo, Chang De-Hua, Joao Ana Alagoa, Goncalves Gil, Mehrabi Arianeb

机构信息

Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany.

Liver Cancer Centre Heidelberg (LCCH), University Hospital Heidelberg, 69120 Heidelberg, Germany.

出版信息

Cancers (Basel). 2024 Feb 13;16(4):771. doi: 10.3390/cancers16040771.

DOI:10.3390/cancers16040771
PMID:38398162
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10887221/
Abstract

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.

摘要

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应用越来越广泛，其适应证也在扩大，以治疗原发性不可切除的肝肿瘤患者。很少有报告建议对肝门部胆管癌（phCC）患者限制甚至禁忌使用ALPPS。在此，我们通过系统评价和汇总数据分析来讨论ALPPS治疗phCC患者的结果。

方法

系统检索MEDLINE和Web of Science数据库中截至2023年12月的相关文献。纳入所有报告ALPPS治疗phCC的研究。进行单臂比例荟萃分析以估计总体结局发生率。

结果

在初步检索获得207篇文章后，我们的系统评价纳入了18项研究的数据，共112例phCC患者。主要并发症发生率和死亡率分别计算为43%和22%。荟萃分析显示术后肝功能衰竭（PHLF）发生率为23%。1年无病生存率为65%，1年总生存率为69%。

结论

与其他治疗选择相比，ALPPS为phCC患者提供了良好的治愈机会，但代价是有争议的发病率和死亡率。随着手术技术的改进和围手术期患者管理的改善，ALPPS治疗phCC患者的结果得到了改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/22f53fb31211/cancers-16-00771-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/3baf38270e03/cancers-16-00771-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/d24e7282669d/cancers-16-00771-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/036e4b8f1310/cancers-16-00771-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/bf4caed052fb/cancers-16-00771-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/4ece48dc937b/cancers-16-00771-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/22f53fb31211/cancers-16-00771-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/3baf38270e03/cancers-16-00771-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/d24e7282669d/cancers-16-00771-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/036e4b8f1310/cancers-16-00771-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/bf4caed052fb/cancers-16-00771-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/4ece48dc937b/cancers-16-00771-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c66/10887221/22f53fb31211/cancers-16-00771-g006.jpg

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