Associating liver partition and portal vein ligation for staged hepatectomy for the treatment of hepatocellular carcinoma

Abstract

Objective To discuss the experience of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for the treatment of hepatocellular carcinoma (HCC). Methods Clinical data of one patient with HCC undergoing ALPPS in Tangdu Hospital of the Forth Military Medical University in March 2015 were retrospectively analyzed. The patient was male, aged 31 years, was hospitalized at 2 weeks after interventional therapy of HCC. He had a history of hepatitis B for over 20 years. No yellow skin or sclera was observed. Percussion pain of hepatic region was positive. HBsAg was positive and the level of AFP was 10 196 μg/L. A massive HCC in the right lobe was observed by computer tomography (CT) scan, approximately 15 cm in diameter. The admitting diagnosis was HCC of the right lobe. Preoperative evaluation: Child-Pugh classification A. The liver volume was 3 464 ml, the right lobe was 2 693 ml and the left lobe was 771 ml assessed by CT scan. After resection of the right lobe and partial inferior left lobe, the remnant liver volume accounted for 35% of the standard liver volume (SLV). The standard remnant liver volume (SRLV) was 328 ml/m2. The patient was unable to tolerate one-stage operation and ALPPS was performed subsequently. The informed consents of the patient was obtained and the local ethical committee approval was received. Results During the first-stage ALPPS, liver separation, removal of portal vein tumor thrombosis, ligation of the right branch of portal vein, partial resection of the inferior left lobe were performed. During the second-stage surgery, right hemihepatectomy was performed and chemotherapy pump was implanted in portal vein. CT scan revealed that the SRLV was 610 ml/m2, and the volume of left liver lobe grew to 1 245 ml, accounting for 86% of SLV 2 weeks after the first-stage of ALPPS. The patient developed massive abdominal hemorrhage following the second-stage surgery and bleeding was stopped after receiving digital subtraction angiography (DSA) of the hepatic artery + embolization. The patient was discharged in stable condition on April 17th, 2015. Conclusions ALPPS is suitable for patients with middle- and advanced-stage HCC who are intolerable of one-stage hepatectomy. For those requiring comprehensive therapy, ALPPS can prolong the survival time of patients to provide the opportunity of receiving subsequent comprehensive treatments. Key words: Carcinoma, hepatocellular; Hepatectomy; Remnant liver volume