Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy.
Division of Hepatobiliary Surgery, Regina Elena Cancer Institute, Rome, Lazio, Italy.
Int J Surg. 2016 Jun;30:38-44. doi: 10.1016/j.ijsu.2016.04.031. Epub 2016 Apr 22.
To report our experience on associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in patients with liver tumors.
ALPPS is a surgical technique that allows hepatic resection after rapid liver hypertrophy.
Thirteen operations were performed: 8 for hepatocellular carcinoma (HCC) with liver cirrhosis (LC) and 5 for colorectal liver metastases (CRLM, n = 3) and cholangiocarcinoma (CC, n = 2) in normal livers (NL). Of the 11 men (85%), the median age was 60 years (range 36-74). Six (75%) HCC patients had BCLC stage C and 2 (25%) had BCLC stage B disease. The median % future liver remnant (FLR) volume increase was 71.7% in patients with LC and 64.8% in NL (p = 0.44). Twelve patients achieved a sufficient FLR growth after the first stage (92.3% efficacy). Four right trisectorectomies and 9 right hepatectomies were performed. All patients completed the second stage (100% feasibility). R0 resection was achieved in all cases. The 90-day mortality rate was 23.1% (12.5% for HCC patients with LC vs 40% for CRLM and CC patients with NL, p = 0.13). After the first stage the overall morbidity rates were 62.5% and 80% (p = 0.61), whereas after the second stage they were 87.5% and 80% in patients with LC and NL respectively (p = 0.99). At a median follow-up of 15 months (range 1-27), the median DFS was 9 months (CI95% 6-12), and the 1yr-DFS was 42%. The median survival was 25 months (CI95% 10-40), and the 1-yr overall survival was 74%.
ALPPS induced a considerable and comparable FLR growth in HCC patients with liver cirrhosis and patients with CRLM and CC with normal liver parenchyma. HCC patients who underwent ALPPS had a high rate of macrovascular tumor involvement. A high rate of R0 resection is expected in properly selected patients.
本文旨在报道我们在接受联合肝脏离断和门静脉结扎的分阶段肝切除术（ALPPS）治疗肝脏肿瘤患者方面的经验。
ALPPS 是一种允许在快速肝增生后进行肝切除术的手术技术。
共进行了 13 例手术：8 例为合并肝硬化的肝细胞癌（HCC），5 例为结直肠癌肝转移（CRLM）和胆管癌（CC），肝脏正常（NL）。11 例男性（85%），中位年龄为 60 岁（范围 36-74 岁）。6 例（75%）HCC 患者为 BCLC 分期 C，2 例（25%）为 BCLC 分期 B。合并肝硬化的患者，术后肝剩余量（FLR）的中位百分比增加为 71.7%，NL 患者为 64.8%（p=0.44）。12 例患者在第一阶段后实现了足够的 FLR 生长（92.3%的疗效）。4 例进行了右三叶切除术，9 例进行了右半肝切除术。所有患者均完成了第二阶段（100%的可行性）。所有病例均达到了 R0 切除。90 天死亡率为 23.1%（合并肝硬化的 HCC 患者为 12.5%，NL 的 CRLM 和 CC 患者为 40%，p=0.13）。第一阶段后，总发病率分别为 62.5%和 80%（p=0.61），第二阶段后分别为 87.5%和 80%，在合并肝硬化和 NL 的患者中（p=0.99）。中位随访时间为 15 个月（范围 1-27），中位无病生存期为 9 个月（95%CI95%6-12），1 年无病生存率为 42%。中位总生存期为 25 个月（95%CI95%10-40），1 年总生存率为 74%。
ALPPS 在合并肝硬化的 HCC 患者和肝脏正常的 CRLM 和 CC 患者中引起了相当大且可比较的 FLR 生长。接受 ALPPS 的 HCC 患者有较高的大血管肿瘤侵犯率。在适当选择的患者中，预计可以实现高比例的 R0 切除。
