Wang Qiang, Ji Yujun, Brismar Torkel B, Chen Shu, Li Changfeng, Jiang Jiayun, Mu Wei, Zhang Leida, Sparrelid Ernesto, Ma Kuansheng
Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Front Surg. 2021 Sep 30;8:741352. doi: 10.3389/fsurg.2021.741352. eCollection 2021.
To evaluate the feasibility and efficacy of sequential portal vein embolization (PVE) and radiofrequency ablation (RFA) (PVE+RFA) as a minimally invasive variant for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) stage-1 in treatment of cirrhosis-related hepatocellular carcinoma (HCC). For HCC patients with insufficient FLR, right-sided PVE was first performed, followed by percutaneous RFA to the tumor as a means to trigger FLR growth. When the FLR reached a safe level (at least 40%) and the blood biochemistry tests were in good condition, the hepatectomy was performed. FLR dynamic changes and serum biochemical tests were evaluated. Postoperative complications, mortality, intraoperative data and long-term oncological outcome were also recorded. Seven patients underwent PVE+RFA for FLR growth between March 2016 and December 2019. The median baseline of FLR was 353 ml (28%), which increased to 539 (44%) ml after 8 (7-18) days of this strategy ( < 0.05). The increase of FLR ranged from 40% to 140% (median 47%). Five patients completed hepatectomy. The median interval between PVE+RFA and hepatectomy was 19 (15-27) days. No major morbidity ≥ III of Clavien-Dindo classification or in-hospital mortality occurred. One patient who did not proceed to surgery died within 90 days after discharge. After a median follow-up of 18 (range 3-50) months, five patients were alive. Sequential PVE+RFA is a feasible and effective strategy for FLR growth prior to extended hepatectomy and may provide a minimally invasive alternative for ALPPS stage-1 for treatment of patients with cirrhosis-related HCC.
评估序贯门静脉栓塞术（PVE）联合射频消融术（RFA）（PVE+RFA）作为一种微创术式用于分期肝切除术（ALPPS）1期肝分隔联合门静脉结扎治疗肝硬化相关肝细胞癌（HCC）的可行性和疗效。对于未来肝残余量（FLR）不足的HCC患者，先进行右侧PVE，然后对肿瘤进行经皮RFA，以此促使FLR生长。当FLR达到安全水平（至少40%）且血液生化检查结果良好时，进行肝切除术。评估FLR的动态变化和血清生化检查结果。记录术后并发症、死亡率、术中数据及长期肿瘤学结局。2016年3月至2019年12月期间，7例患者接受PVE+RFA以促进FLR生长。FLR的中位基线值为353 ml（28%），采用该策略8（7-18）天后增至539（44%）ml（<0.05）。FLR的增幅为40%至140%（中位值47%）。5例患者完成了肝切除术。PVE+RFA与肝切除术之间的中位间隔时间为19（15-27）天。未发生Clavien-Dindo分类中≥III级的严重并发症或院内死亡。1例未进行手术的患者在出院后90天内死亡。中位随访18（3-50）个月后，5例患者存活。序贯PVE+RFA是在扩大肝切除术前促进FLR生长的一种可行且有效的策略，可能为治疗肝硬化相关HCC患者的ALPPS 1期提供一种微创替代方案。
