A single center comparative retrospective study of in situ split plus portal vein ligation versus conventional two-stage hepatectomy for cholangiocellular carcinoma

Abstract

Introduction

Cholangiocellular carcinoma (CCA) has a poor prognosis and the goldstandard even in locally advanced cases remains radical surgical resection. This approach however is limited by the future liver remnant volume (FLRV) after extensive parenchymal dissection leading to post-operative liver failure and high mortality rates. The aim of this study was to compare the outcome of in situ liver transection with portal vein ligation (ISLT) procedure and conventional two-stage hepatectomy with portal vein embolization (PVE/TSH) in patients with CCA.

Methods

All patients with CCA and insufficient FLR considered for either ISLT or PVE/TSH were analyzed for outcomes including post-operative morbidity, mortality, and overall survival rates (OS).

Results

Sixteen patients received ISLT and eight patients underwent PVE/TSH. The completion rate of the second stage in the PVE/TSH group was 62% and 100% in the ISLT group (p = 0.027). The overall 90-day morbidity rates including severe complications (Clavien-Dindo ≥3b) were comparable (PVE/TSH 40% vs. ISLT 69%, p = 0.262). The median OS (PVE/TSH 7 months vs. ISLT 3 months) and the 90-day mortality rates (PVE/TSH 0% vs. ISLT 50%) did not significantly differ between the two groups (p > 0.05). In multivariate analysis, biliary resection and reconstruction was the only risk factor independently associated with 90-day post-operative morbidity [HR = 20.0; 95%CI (1.68–238.63); p = 0.018].

Conclusion

Our results demonstrate comparable outcomes in both groups in a rather prognostically unfavorable disease. The completion rate in the ISLT group was significantly higher than in the PVE/TSH cohort. This work encourages specialized hepato-biliary-pancreatic centers in applying the ISLT procedure in selected cases with CCA.

Keywords:

• Cholangiocellular carcinoma
• extended hepatic resection
• ISLT
• PVE

Ethical approval

This study was approved by the local institutional review board (Heinrich Heine University, Duesseldorf, Germany; study-no.: 2018-258-KFogU). All procedures performed in this study were in accordance with the ethical standards in the 1964 Declaration of Helsinki and its later amendments. Informed consent was waived because no data regarding the cases were disclosed.

Author contributions

S.V., S.A., D.P., N.L., S-A. S., A.R., A.K., L.K., and L.S.: study conception, design and overall analysis and interpretation of data, drafting, revising the manuscript. S.V., S.A., N.L., D.P., L.K., and L.S.: data analysis and interpretation. S.V., S.A., D.P., and N.L.: manuscript preparation. S.V. and D.P.: data presentation. S.V., N.L, and W.T.K.: conceptual contributions and manuscript revision. All authors have read and approved the manuscript.

Disclosure statement

The authors report no conflict of interest.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.