Zhang Junwei, Xu Yiyao, Yang Huayu, Huang Hanchun, Bian Jin, Jiang Shitao, Sang Xinting, Mao Yilei, Zhao Haitao, Du Shunda, Xu Haifeng, Zheng Yongchang, Chi Tianyi, Lu Xin
Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China.
Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences (CAMS), Beijing, China.
Transl Cancer Res. 2020 Sep;9(9):5371-5379. doi: 10.21037/tcr-19-2633.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been suggested to cause rapid liver hypertrophy among patients having inadequate future liver remnant (FLR). However, ALPPS is still considered as a controversial hepatocellular carcinoma (HCC) treatment, especially for those with cirrhosis. This is ascribed to the high mortality and morbidity. The present study aimed to evaluate the ALPPS safety and feasibility for HCC patients related to hepatitis B virus (HBV).
This was a retrospective observational study. Consecutive HCC cases undergoing ALPPS or RH at our hospital between September 2014 and June 2018 were included. The demographic and clinical data of patients were collected, and oncological results of ALPPS patients were compared with those receiving right hepatectomy (RH).
A total of 14 ALPPS patients and 21 RH patients were consecutively collected between September 2014 and June 2018. All ALPPS patients received stage II operations, with 100% resection of R0. The median growth of FLR between operations was 48% (range, ‒0.06% to 100%) in 17 days (range, 9-30 days). 3 ALPPS patients (21.4%) suffered from severe complications (grade ≥IIIb) according to the Clavien-Dindo grade, including 1 with renal failure, and 2 with the FLR/SLV of <30% and liver failure, and 1 (4.8%) with severe complication (liver failure) after the stage I RH. Difference in the long-term survival, either overall survival (OS) or disease-free survival (DFS), between ALPPS and RH was not statistically significant.
Our results suggest that ALPPS should be performed in highly selected patients with cirrhosis. Patients with 30%< the FLR/SLV <30% and ages <60 years old are recommended. And a longer interval time between stages is suggested to improve the safety of ALPPS. Because the long-term survival after ALPPS is similar to that after RH, which indicates that the long waiting time between stage does not increase the risk of tumor progression.
最近有人提出，联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）可使未来肝残余量（FLR）不足的患者肝脏快速肥大。然而，ALPPS仍被认为是一种有争议的肝细胞癌（HCC）治疗方法，尤其是对于那些患有肝硬化的患者。这归因于其高死亡率和高发病率。本研究旨在评估ALPPS对乙型肝炎病毒（HBV）相关HCC患者的安全性和可行性。
这是一项回顾性观察研究。纳入2014年9月至2018年6月在我院接受ALPPS或右半肝切除术（RH）的连续HCC病例。收集患者的人口统计学和临床数据，并将ALPPS患者的肿瘤学结果与接受右半肝切除术（RH）的患者进行比较。
2014年9月至2018年6月连续收集了14例ALPPS患者和21例RH患者。所有ALPPS患者均接受了二期手术，R0切除率为100%。手术期间FLR的中位生长率在17天（范围9 - 30天）内为48%（范围 - 0.06%至100%）。根据Clavien - Dindo分级，3例ALPPS患者（21.4%）发生严重并发症（≥IIIb级），包括1例肾衰竭，2例FLR/SLV<30%并伴有肝衰竭，1例（4.8%）在一期RH后发生严重并发症（肝衰竭）。ALPPS组与RH组之间的长期生存率，无论是总生存期（OS）还是无病生存期（DFS），差异均无统计学意义。
我们的结果表明，ALPPS应在经过严格筛选的肝硬化患者中进行。建议选择FLR/SLV在30%至<30%之间且年龄<60岁的患者。并且建议在分期之间延长间隔时间以提高ALPPS的安全性。因为ALPPS后的长期生存率与RH后的相似，这表明分期之间的长时间等待不会增加肿瘤进展的风险。
