title: High mortality after ALPPS for perihilar cholangiocarcinoma: case-control analysis including the first series from the international ALPPS registry.
abstract: Resection of perihilar cholangiocarcinoma (PHC) entails high-risk surgery with postoperative mortality reported up to 18%, even in specialized centers. The aim of this study was to compare outcomes of PHC patients who underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to patients who underwent resection without ALPPS.
  
  
  
  All patients who underwent ALPPS for PHC were identified from the international ALPPS registry and matched controls were selected from a standard resection cohort from two centers based on future remnant liver size. Outcomes included morbidity, mortality, and overall survival.
  
  
  
  ALPPS for PHC was associated with 48% (14/29) 90-day mortality. 90-day mortality was 13% in 257 patients who underwent major liver resection for PHC without ALPPS. The 29 ALPPS patients were matched to 29 patients resected without ALPPS, with similar future liver remnant volume (P = 0.480). Mortality in the matched control group was 24% (P = 0.100) and median OS was 27 months, comparted to 6 months after ALPPS (P = 0.064).
  
  
  
  Outcomes of ALPPS for PHC appear inferior compared to standard extended resections in high-risk patients. Therefore, portal vein embolization should remain the preferred method to increase future remnant liver volume in patients with PHC. ALPPS is not recommended for PHC.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: p.b.olthof@amc.nl.
authors.forename: Pim B
authors.initials: PB
authors.lastname: Olthof
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Robert J S
authors.initials: RJS
authors.lastname: Coelen
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jimme K
authors.initials: JK
authors.lastname: Wiggers
authors.affiliation: Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Groot Koerkamp
authors.affiliation: Department of HPB and Liver Transplant Surgery, Royal Free Hospital, University College London, London, United Kingdom.
authors.forename: Massimo
authors.initials: M
authors.lastname: Malago
authors.affiliation: Department of Surgery, Western University Medical Center, London, Ontario, Canada; Devision of Transplantation, University of Rochester, New York, United States.
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernandez-Alejandro
authors.affiliation: Department of Surgery, University Hospital Düsseldorf, Germany.
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Topp
authors.affiliation: Department of Surgery, Azienda Ospedaliero Universitaria - Ospedali Riuniti di Ancona, Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.affiliation: Department of Surgery, San Raffaele Hospital, Milano, Italy.
authors.forename: Luca A
authors.initials: LA
authors.lastname: Aldrighetti
authors.affiliation: Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Robles Campos
authors.affiliation: Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Faculty of Medicine, Semmelweis University Campus Hamburg, Germany.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Oldhafer
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States.
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009519:New York City; D011169:Portal Vein / Q000601:surgery*; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome