Maupoey Ibáñez Javier, Montalvá Orón Eva María, Boscà Robledo Andrea, Camacho Ramírez Alonso, Hernando Sanz Ana, Granero Castro Pablo, Alegre Delgado Alberto, López-Andújar Rafael
Hepatobiliary Surgery and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.
Hepatobiliary Surgery and Transplant Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.
Hepatobiliary Pancreat Dis Int. 2021 Dec;20(6):542-550. doi: 10.1016/j.hbpd.2021.08.001. Epub 2021 Aug 14.
Hepatectomy in patients with large tumor load may result in postoperative liver failure and associated complications due to excessive liver parenchyma removal. Conventional two-stage hepatectomy (TSH) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique are possible solutions to this problem. Colorectal liver metastases (CRLM) is the most frequent indication, and there is a need to assess outcomes for both techniques to improve surgical and long-term oncological outcomes in these patients.
A single-center retrospective study was designed to compare TSH with ALPPS in patients with initially unresectable bilateral liver tumors between January 2005 and January 2020. ALPPS was performed from January 2012 onwards as the technique of choice. Long-term overall survival (OS) and disease-free survival (DFS) were evaluated as primary outcome in CRLM patients. Postoperative morbidity, mortality and liver growth in all patients were also evaluated.
A total of 38 staged hepatectomies were performed: 17 TSH and 21 ALPPS. Complete resection rate was 76.5% (n = 13) in the TSH group and 85.7% (n = 18) in the ALPPS group (P = 0.426). Overall major morbidity (Clavien-Dindo ≥ 3a) (stage 1 + stage 2) was 41.2% (n = 7) in TSH and 33.3% (n = 7) in ALPPS patients (P = 0.389), and perioperative 90-day mortalities were 11.8% (n = 2) vs. 19.0% (n = 4) in each group, respectively (P = 0.654). Intention-to-treat OS rates at 1 and 5 years in CRLM patients for TSH (n = 15) were 80% and 33%, and for ALPPS (n = 17) 76% and 35%, respectively. DFS rates at 1 and 5 years were 36% and 27% in the TSH group vs. 33% and 27% in the ALPPS group, respectively.
ALPPS is an effective alternative to TSH in bilateral affecting liver tumors, allowing higher resection rate, but patients must be carefully selected. In CRLM patients similar long-term OS and DFS can be achieved with both techniques.
肿瘤负荷大的患者进行肝切除时，由于切除过多肝实质，可能导致术后肝衰竭及相关并发症。传统的两阶段肝切除术（TSH）和联合肝脏分隔与门静脉结扎分期肝切除术（ALPPS）技术可能是解决这一问题的方法。结直肠癌肝转移（CRLM）是最常见的适应证，需要评估这两种技术的疗效，以改善这些患者的手术及长期肿瘤学预后。
一项单中心回顾性研究旨在比较2005年1月至2020年1月期间，初始不可切除的双侧肝肿瘤患者的TSH和ALPPS。自2012年1月起，将ALPPS作为首选技术。将CRLM患者的长期总生存（OS）和无病生存（DFS）作为主要结局进行评估。还评估了所有患者的术后发病率、死亡率和肝脏生长情况。
共进行了38例分期肝切除术：17例TSH和21例ALPPS。TSH组的完全切除率为76.5%（n = 13），ALPPS组为85.7%（n = 18）（P = 0.426）。TSH患者的总体严重并发症（Clavien-Dindo≥3a）（1期+2期）为41.2%（n = 7），ALPPS患者为33.3%（n = 7）（P = 0.389），每组的围手术期90天死亡率分别为11.8%（n = 2）和19.0%（n = 4）（P = 0.654）。CRLM患者中，TSH（n = 15）组1年和5年的意向性治疗OS率分别为80%和33%，ALPPS（n = 17）组分别为76%和35%。TSH组1年和5年的DFS率分别为36%和27%，ALPPS组分别为33%和27%。
在双侧累及肝脏的肿瘤中，ALPPS是TSH的有效替代方法，可实现更高的切除率，但必须仔细选择患者。两种技术在CRLM患者中均可实现相似的长期OS和DFS。
