Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma

Abstract EN

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.