Abstract
BackgroundThe feasibility of association liver partition and portal vein ligation for staged hepatectomy (ALPPS) for solitary huge hepatocellular carcinoma (HCC, maximal diameter ≥ 10 cm) remains uncertain. This study aims to evaluate the safety and the efficacy of ALPPS for patients with solitary huge HCC.MethodsTwenty patients with solitary huge HCC who received ALPPS during January 2017 and December 2019 were retrospectively analyzed. The oncological characteristics of contemporaneous patients who underwent one-stage resection and transcatheter arterial chemoembolization (TACE) were compared using propensity score matching (PSM).ResultsAll patients underwent complete two-staged ALPPS. The median future liver remnant from the ALPPS-I stage to the ALPPS-II stage increased by 64.5% (range = 22.3–221.9%) with a median interval of 18 days (range = 10–54 days). The 90-day mortality rate after the ALPPS-II stage was 5%. The 1- and 3-year overall survival (OS) rates were 70.0% and 57.4%, respectively, whereas the 1- and 3-year progression-free survival (PFS) rates were 60.0% and 43.0%, respectively. In the one-to-one PSM analysis, the long-term survival of patients who received ALPPS was significantly better than those who received TACE (OS, P = 0.007; PFS, P = 0.011) but comparable with those who underwent one-stage resection (OS, P = 0.463; PFS, P = 0.786).ConclusionThe surgical outcomes of ALPPS were superior to those of TACE and similar to those of one-stage resection. ALPPS is a safe and effective treatment strategy for patients with unresectable solitary huge HCC.
Highlights
The feasibility of association liver partition and portal vein ligation for staged hepatectomy (ALPPS) for solitary huge hepatocellular carcinoma (HCC, maximal diameter ≥ 10 cm) remains uncertain
In accordance with the Child-Pugh classification, 19 (95%) and 1 (5%) patients were classified as classes A and B, respectively, whereas in accordance with the Barcelona Clinic Liver Cancer staging, 7 (35%), 5 (25%), and 8 (40%) patients were classified as stages A, B, and C, respectively
The present study has focused on patients with solitary huge Hepatocellular carcinoma (HCC) and compared the efficacy and the safety of ALPPS, one-stage resection, and transcatheter arterial chemoembolization (TACE)
Summary
The feasibility of association liver partition and portal vein ligation for staged hepatectomy (ALPPS) for solitary huge hepatocellular carcinoma (HCC, maximal diameter ≥ 10 cm) remains uncertain. Surgical resection allows patients to acquire better long-term survival than other treatments in most cases [3, 4] and remains the major treatment for HCC [2, 5]. Patients with huge HCC frequently lose the chance of radical treatment, thereby limiting the feasibility of the hepatic resection. Previous studies indicate that the 5-year overall survival (OS) in patients with huge HCC who have undergone nonsurgical treatment is less than 20%, which is significantly lower than those who have undergone surgical resection (about 25– 40%) [6,7,8]
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