Preoperative Trans-catheter Arterial Chemoembolization and Laparoscopic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in Unresectable Hepatocellular Carcinoma &amp;ndash; A Case Report

Yilin Hu,Yanbing Shen,Tingjia Cao,Dan Wang

doi:10.51441/biomedica/5-284

Abstract

<p>Transcatheter arterial chemoembolization (TACE) is considered as a major method to treat hepatocellular carcinoma (HCC). Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been used to treat patients with advanced HCC. This case report documents the safety, efficacy, and feasibility of TACE and laparoscopic ALPPS to treat the unresectable HCC of the right liver with right intra-hepatic metastasis in a male patient. Percutaneous and trans-femoral artery TACE was performed preoperatively, and the ALPPS stage-I at the 4th week and stage-II after 14 days was carried out. Postoperative outcome was assessed after 180 days of follow-up. It is concluded that preoperative TACE and laparoscopic ALPPS offer a fine treatment alternative to the patients with insufficient residual liver volume and relatively-advanced and extensive HCC.</p>

Highlights

Hepatectomy and transcatheter arterial chemoembolization (TACE) are still two major methods to treat hepatocellular carcinoma (HCC)
In the following case report, Transcatheter arterial chemoembolization (TACE) was performed on one patient with extensive HCC of right liver followed by laparoscopic-ALPPS achieving a better curative effect
Nishikawa et al [7] reported in the latest randomized control trail that preoperative TACE is a safe and reliable method with synergistic effects in the postoperative outcome

Summary

Introduction

Hepatectomy and transcatheter arterial chemoembolization (TACE) are still two major methods to treat hepatocellular carcinoma (HCC). Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) is considered as a good method of choice for relatively advanced HCC patients with limited FLR and compromised tolerance to the massive hepatectomy. Laparoscopic liver parenchymal segmentation and right portal vein ligation and cholecystectomy were carried out, namely, the ALPPS stage-I. At the 12th day after the stage-I associating liver partition and portal vein ligation for staged hepatectomy (ALPSS), the enhanced CT examination was carried out (Figure 4a,b) and the liver volume was measured (Table 1). When no blood and bile leakage were ensured, one drainage tube was placed on the wound surface and the sample was taken (Figure 4d). Postoperative biopsy from the liver revealed poorly differentiated HCC with metastasis in the adjacent nodes

Findings

Discussion

Conclusion