title: Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma.
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.
authors.affiliation: Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Oldhafer
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hannover Medical School, 30625 Hannover, Germany.
authors.forename: K I
authors.initials: KI
authors.lastname: Ringe
authors.affiliation: Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Timrott
authors.affiliation: Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kleine
authors.affiliation: Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Ramackers
authors.affiliation: Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Cammann
authors.affiliation: Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
authors.forename: M D
authors.initials: MD
authors.lastname: Jäger
authors.affiliation: Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Klempnauer
authors.affiliation: Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Bektas
authors.affiliation: Regenerative Medicine & Experimental Surgery (ReMediES), Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
authors.forename: F W R
authors.initials: FW
authors.lastname: Vondran