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

Abstract

Objective To investigate the safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of hepatocellular carcinoma (HCC). Methods Clinical data of 2 patients with HCC who underwent ALPPS in the Third Affiliated Hospital of Sun Yat-sen University between September 2014 and November 2014 were retrospectively analyzed. The informed consents of 2 patients were obtained and the local ethical committee approval was received. Case 1 was a 46-year-old male with the body weight (BW) of 51 kg, AFP>2 000 μg/L, and the liver function was graded as Child-Pugh class A. Abdominal CT scan revealed a massive HCC of 11 cm × 10 cm in size in the Ⅶ/Ⅷ liver segments. The future remnant liver volume (FRLV) was 378 ml. The estimated standard liver volume (ESLV) was 915 ml. The FRLV/ESLV ratio was 41%. The future remnant liver weight (FRLW) was 318 g. The FRLV/BW ratio was 0.62%. Case 2 was a 30-year-old male with the BW of 53 kg, AFP 42 326 μg/L, and the liver function was graded as Child-Pugh class A. Abdominal CT scan revealed a massive HCC of 11 cm × 11 cm in size in the middle liver segment. The FRLV/ESLV ratio was 31% and the FRLW/BW ratio was 0.45%. During the first operation, the right branch of portal vein was separated and ligated. The left liver lobe was partitioned along with the right falciform ligament. Two patients underwent right hepatic trisectionectomy at 28, 14 d after the first operation. Results The FRLV of case 1 was 504 ml at 17 d after the first operation, and increased 33% compared with preoperative FRLV. The FRLV/ESLV increased from 41% of preoperation to 55%. The FRLW/BW increased from 0.62% of preoperation to 0.81%. The FRLV of case 2 was 574 ml at7 d after the first operation, and increased 100% compared with preoperative FRLV. The FRLV/ESLV increased from 31% of preoperation to 53%. The FRLW/BW increased from 0.45% of preoperation to 0.91%. Case 1 and 2 were successfully discharged at postoperative 45 and 24 d. Conclusions ALPPS offers a novel option for the treatment of HCC patients with insufficient FRLV. Key words: Carcinoma, hepatocellular; Hepatectomy; Future remnant liver volume; Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)