Intrahepatic Cholangiocarcinoma Clinical Trial
Official title:
Split-in-situ Resection With Radio-frequency Ablation Instead of Liver Partition on the First Stage (RALPPS) in Patients With Hilar and Intrahepatic Cholangiocarcinoma
Unsatisfactory immediate outcomes of Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in surgery of cholangiocarcinoma suggested that patients with biliary cancer should not be treated by ALPPS. Short-term results of ALPPS variants with reduced surgical trauma on the first stage in patients with cholangiocarcinoma were not yet estimated. The objective of the study was estimation of the short-term results of split-in-situ resection with radio-frequency ablation (RFA) instead of liver partition on the first stage (RALPPS) in patients with hilar (h-CCA) and intrahepatic (i-CCA) cholangiocarcinoma compared with portal vein embolization (PVE).
ALPPS has been recently proposed as the most effective method to induce marked and rapid
hypertrophy of FLR with 95-100% completion rate of the second stage. The most common
indication for ALPPS is locally advanced multiple colorectal liver metastases. Unsatisfactory
immediate outcomes of ALPPS in surgery of cholangiocarcinoma (CCA) including high mortality
reached 48% in patients with h-CCA suggested that patients with biliary cancer should not be
treated by ALPPS.
Recently reported modifications of in situ splitting (partial ALPPS, RALPPS
(radio-frequency-assisted liver partition with portal vein ligation for staged hepatectomy)
and ALTPS (associating liver tourniquet and right portal vein ligation for staged
hepatectomy) etc) have been aimed to minimize the operating injury on the first stage, hereby
reducing postoperative morbidity.
The other important idea was to preserve all initial benefits of ALPPS in terms of liver
hypertrophy and completeness of the second stage. To date, there is no evidence of the
benefits of any new ALPPS modification over others in reducing the morbidity of procedure,
particularly in patients with CCA..
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