Cai Xiujun, Tong Yifan, Yu Hong, Liang Xiao, Wang Yifan, Liang Yuelong, Li Zheyong, Peng Shuyong, Lau W Y
1 Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, China.
2 Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
Surg Innov. 2017 Aug;24(4):358-364. doi: 10.1177/1553350617697187. Epub 2017 Mar 12.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been reported to be a new treatment strategy for patients with predicted small volumes of future liver remnant (FLR). ALPPS is associated with rapid hypertrophy of FLR but it has a high postoperative mortality and morbidity. Up to now, it is controversial to apply ALPPS in hepatocellular carcinoma, especially for patients with liver cirrhosis.
Between May 2014 and June 2015, consecutive patients who underwent ALPPS with hepatitis B-related hepatocellular carcinoma with cirrhosis carried out in our center were included into the study. Demographic characteristics, surgical outcomes, and pathological results were evaluated. Subsequently, follow-up was still in progress.
The median operating time of the first (n = 12) and the second procedures (n = 10) were 285.0 and 212.5 minutes, respectively. The median blood loss were 200 and 800 mL for 2 stages of operations. The severe complication (≥IIIB) rates for the first and the second operations were 25.0% versus 40.0%, respectively. Six patients with too small future live remnant died of postoperative hepatic failure. On a median follow-up of 16 months of the 6 patients discharged, 4 patients were still alive and of 2 were disease-free.
In terms of the feasibility and safety, this study showed that ALPPS in the treatment of hepatocellular carcinoma with insufficient future liver remnant might be a double-edged sword, and careful patients selected was proposed. Too small of FLR/SLV, less than 30%, is not recommended for ALPPS in liver with cirrhosis.
据报道，联合肝脏分隔和门静脉结扎的分期肝切除术（ALPPS）是一种针对预计未来肝剩余体积（FLR）较小患者的新治疗策略。ALPPS与FLR的快速肥大相关，但术后死亡率和发病率较高。到目前为止，在肝细胞癌中应用ALPPS存在争议，尤其是对于肝硬化患者。
2014年5月至2015年6月，本中心连续纳入接受ALPPS治疗的乙型肝炎相关肝细胞癌合并肝硬化患者进行研究。评估人口统计学特征、手术结果和病理结果。随后，随访仍在进行中。
第一次手术（n = 12）和第二次手术（n = 10）的中位手术时间分别为285.0分钟和212.5分钟。两阶段手术的中位失血量分别为200毫升和800毫升。第一次和第二次手术的严重并发症（≥IIIB）发生率分别为25.0%和40.0%。6例未来肝剩余过小的患者死于术后肝衰竭。在对6例出院患者进行的中位16个月随访中，4例患者仍存活，2例无疾病。
就可行性和安全性而言，本研究表明，ALPPS治疗未来肝剩余不足的肝细胞癌可能是一把双刃剑，建议谨慎选择患者。对于肝硬化肝脏，不建议对FLR/SLV小于30%的患者采用ALPPS。
