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Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma.

Oldhafer F, Ringe KI, Timrott K, Kleine M, Ramackers W, Cammann S, Jäger MD, Klempnauer J, Bektas H, Vondran FW - Case Rep Surg (2015)

Bottom Line: Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan.Discussion.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.

ABSTRACT
Background. Surgical resection remains the best treatment option for intrahepatic cholangiocarcinoma (ICC). Two-stage liver resection combining in situ liver transection with portal vein ligation (ALPPS) has been described as a promising method to increase the resectability of liver tumors also in the case of ICC. Presentation of Case. A 46-year-old male patient presented with an ICC-typical lesion in the right liver. The indication for primary liver resection was set and planed as a right hepatectomy. In contrast to the preoperative CT-scan, the known lesion showed further progression in a macroscopically steatotic liver. Therefore, the decision was made to perform an ALPPS-procedure to avoid an insufficient future liver remnant (FLR). The patient showed an uneventful postoperative course after the first and second step of the ALPPS-procedure, with sufficient increase of the FLR. Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan. Discussion. The presented case demonstrates that an intraoperative conversion to an ALPPS-procedure is safely applicable when the FLR surprisingly seems to be insufficient. Conclusion. ALPPS should also be considered a treatment option in well-selected patients with ICC. However, the experience concerning the outcome of ALPPS in case of ICC remains fairly small.

No MeSH data available.


Related in: MedlinePlus

Postoperative course of AST, Bilirubin, and Quick value. Diagram depicting the courses of AST, Bilirubin, and Quick value following the first and second step of the ALPPS-procedure, respectively.
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fig2: Postoperative course of AST, Bilirubin, and Quick value. Diagram depicting the courses of AST, Bilirubin, and Quick value following the first and second step of the ALPPS-procedure, respectively.

Mentions: A CT-volumetry conducted on postoperative day (POD) 10 showed FLR volume of 591 cm3 (approximately 43% of the total liver volume) resulting in a volume increase of about 103% following step 1 of ALPPS. AST and ALT levels primarily were significantly elevated to 1598 U/I and 1429 U/I on POD 2 but constantly dropped thereafter and were 80 U/I and 118 U/I on POD 10, respectively (Figure 2). An adequate recovery of liver functions as monitored amongst others by the Quick value (Figure 2).


Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma.

Oldhafer F, Ringe KI, Timrott K, Kleine M, Ramackers W, Cammann S, Jäger MD, Klempnauer J, Bektas H, Vondran FW - Case Rep Surg (2015)

Postoperative course of AST, Bilirubin, and Quick value. Diagram depicting the courses of AST, Bilirubin, and Quick value following the first and second step of the ALPPS-procedure, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4663318&req=5

fig2: Postoperative course of AST, Bilirubin, and Quick value. Diagram depicting the courses of AST, Bilirubin, and Quick value following the first and second step of the ALPPS-procedure, respectively.
Mentions: A CT-volumetry conducted on postoperative day (POD) 10 showed FLR volume of 591 cm3 (approximately 43% of the total liver volume) resulting in a volume increase of about 103% following step 1 of ALPPS. AST and ALT levels primarily were significantly elevated to 1598 U/I and 1429 U/I on POD 2 but constantly dropped thereafter and were 80 U/I and 118 U/I on POD 10, respectively (Figure 2). An adequate recovery of liver functions as monitored amongst others by the Quick value (Figure 2).

Bottom Line: Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan.Discussion.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.

ABSTRACT
Background. Surgical resection remains the best treatment option for intrahepatic cholangiocarcinoma (ICC). Two-stage liver resection combining in situ liver transection with portal vein ligation (ALPPS) has been described as a promising method to increase the resectability of liver tumors also in the case of ICC. Presentation of Case. A 46-year-old male patient presented with an ICC-typical lesion in the right liver. The indication for primary liver resection was set and planed as a right hepatectomy. In contrast to the preoperative CT-scan, the known lesion showed further progression in a macroscopically steatotic liver. Therefore, the decision was made to perform an ALPPS-procedure to avoid an insufficient future liver remnant (FLR). The patient showed an uneventful postoperative course after the first and second step of the ALPPS-procedure, with sufficient increase of the FLR. Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan. Discussion. The presented case demonstrates that an intraoperative conversion to an ALPPS-procedure is safely applicable when the FLR surprisingly seems to be insufficient. Conclusion. ALPPS should also be considered a treatment option in well-selected patients with ICC. However, the experience concerning the outcome of ALPPS in case of ICC remains fairly small.

No MeSH data available.


Related in: MedlinePlus