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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

Follow-up CT-scan. Follow-up CT-scan approximately 2.5 months after liver resection showing the further volume increase of the liver remnant (a). Furthermore, examples of the novel extrahepatic tumor manifestations in terms of peritoneal carcinosis (b) as well as lung metastases (c) are shown (marked by red circles, resp.).
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fig3: Follow-up CT-scan. Follow-up CT-scan approximately 2.5 months after liver resection showing the further volume increase of the liver remnant (a). Furthermore, examples of the novel extrahepatic tumor manifestations in terms of peritoneal carcinosis (b) as well as lung metastases (c) are shown (marked by red circles, resp.).

Mentions: One month after discharge the patient presented in the outpatient clinic with thoracic discomfort. A follow-up CT-scan of the abdomen and chest was performed and revealed suspicious lesions in the left lung (at least 3 tumor lesions) and the peritoneum (at least 2 lesions suspicious of peritoneal carcinosis) (Figure 3). Consequently, a palliative chemotherapy was started with gemcitabine and cisplatin. However, the patient had to stop the chemotherapy due to severe side effects and passed away within 2.5 months after the tumor resection.


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)

Follow-up CT-scan. Follow-up CT-scan approximately 2.5 months after liver resection showing the further volume increase of the liver remnant (a). Furthermore, examples of the novel extrahepatic tumor manifestations in terms of peritoneal carcinosis (b) as well as lung metastases (c) are shown (marked by red circles, resp.).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: Follow-up CT-scan. Follow-up CT-scan approximately 2.5 months after liver resection showing the further volume increase of the liver remnant (a). Furthermore, examples of the novel extrahepatic tumor manifestations in terms of peritoneal carcinosis (b) as well as lung metastases (c) are shown (marked by red circles, resp.).
Mentions: One month after discharge the patient presented in the outpatient clinic with thoracic discomfort. A follow-up CT-scan of the abdomen and chest was performed and revealed suspicious lesions in the left lung (at least 3 tumor lesions) and the peritoneum (at least 2 lesions suspicious of peritoneal carcinosis) (Figure 3). Consequently, a palliative chemotherapy was started with gemcitabine and cisplatin. However, the patient had to stop the chemotherapy due to severe side effects and passed away within 2.5 months after the tumor resection.

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