Department of Hepatobiliary Surgery and Liver transplantation, the First Affiliated Hospital of Guangxi Medical University, Shuangrong Raod 6, Nanning, 530021, China.
Department of Radiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
J Gastrointest Surg. 2021 Sep;25(9):2280-2288. doi: 10.1007/s11605-021-05022-0. Epub 2021 May 7.
Hepatocellular carcinoma (HCC) patients often developed hepatic arterioportal fistula (APF). The aim of this study is to evaluate the impact of APF on future liver remnant (FLR) regeneration and surgical outcomes after the first stage of associating liver partition and portal vein ligation for staged hepatectomy (stage-I ALPPS).
Consecutive HCC patients who underwent ALPPS at our center between March 2017 and May 2019 were retrospectively studied. Data for the association between APF and clinicopathological details, liver volume, and surgical outcomes were analyzed.
The enrolled 35 HCC patients were divided into three groups: 15 patients with preoperative APF were classified as the APF I group, 10 patients developed APF after stage-I ALPPS as the APF II group, whereas the other 10 patients without APF before and after stage-I ALPPS as the control group. After stage-I ALPPS, patients in the APF I and APF II groups had lower kinetic growth rate (KGR) of FLR volume (6.1±3.2%, 11.4±8.4%, 25.0±8.8% per week, respectively, P<0.001) and took longer median time to reach the sufficient FLR volume for stage-II ALPPS (17.5 days, 12 days, 6 days, respectively, P<0.001) than those in the control group. Meanwhile, the incidence of posthepatectomy liver failure (PHLF) in the APF I and APF II groups was significantly higher than that of the control group (P=0.007). There are 27 (77.1%) patients who completed stage-II ALPPS. The overall survival (OS) rates at 1 and 3 years were 59.3% and 35.1%, whereas the disease-free survival (DFS) rates at 1 and 3 years were 44.4% and 22.9%, respectively.
Hepatic APF is significantly associated with decreased FLR regeneration and a higher risk of PHLF after stage-I ALPPS. HCC patients who are to undergo ALPPS may benefit from the timely perioperative intervention of APF.
肝细胞癌（HCC）患者常发生肝动脉门静脉瘘（APF）。本研究旨在评估 APF 对第一阶段联合肝脏分隔和门静脉结扎分期肝切除术（一期 ALPPS）后剩余肝脏（FLR）再生和手术结果的影响。
回顾性分析 2017 年 3 月至 2019 年 5 月在我院接受 ALPPS 的连续 HCC 患者。分析了 APF 与临床病理特征、肝体积和手术结果之间的关系。
纳入的 35 例 HCC 患者分为三组：15 例术前有 APF 的患者分为 APF I 组，10 例在一期 ALPPS 后发生 APF 的患者分为 APF II 组，而另外 10 例在一期 ALPPS 前后无 APF 的患者分为对照组。在一期 ALPPS 后，APF I 组和 APF II 组的 FLR 体积的动力学增长率（KGR）较低（分别为 6.1±3.2%、11.4±8.4%、25.0±8.8%/周，P<0.001），达到二期 ALPPS 所需的足够 FLR 体积的中位时间也较长（分别为 17.5 天、12 天、6 天，P<0.001），比对照组长。同时，APF I 组和 APF II 组的术后肝衰竭（PHLF）发生率明显高于对照组（P=0.007）。有 27 例（77.1%）患者完成了二期 ALPPS。1 年和 3 年的总生存率（OS）分别为 59.3%和 35.1%，1 年和 3 年的无病生存率（DFS）分别为 44.4%和 22.9%。
肝 APF 与一期 ALPPS 后 FLR 再生减少和 PHLF 风险增加显著相关。接受 ALPPS 的 HCC 患者可能受益于 APF 的及时围手术期干预。
