Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital of Rome, Circonvallazione Gianicolense 87, 00152, Rome, Italy.
Updates Surg. 2022 Jun;74(3):927-936. doi: 10.1007/s13304-022-01277-7. Epub 2022 Mar 19.
Patients with advanced hepatocellular carcinoma (HCC) and macrovascular invasion (MVI) have dismal prognosis and are referred to systemic treatment or palliation. To investigate the outcomes of patients with HCC and MVI undergoing the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure. Demographics and operative data were retrospectively reviewed. All types of hepatectomies and all types of ALPPS modifications were included. MVI was categorized according to the Japanese Liver Cancer Study Group classification. 28 patients were included. Viral aetiology was the most common cause of chronic liver disease (89.3%). 85.7% of patients were cirrhotic, with a median MELD score of 9 (7-10). MVI of the hepatic veins or inferior vena cava was diagnosed in 46.4% of patients while portal vein involvement was present in 64.2% of cases. Four patients (14.2%) were diagnosed with bile duct involvement. No patients died after Step 1 while complications occurred in 21.4% of cases. Following step 2, 3 patients (11.5%) died and 20 (69.2%) developed complications. Grade B and C post-hepatectomy liver failure occurred in 57.6% and 11.5% of patients, respectively. After a median follow-up of 18 months (7-35), median survival was 22 months (3-40). Eleven patients (39.3%) recurred. Median disease-free survival was 15 months (5-26). The ALPPS procedure is an extreme rescue approach in otherwise inoperable advanced HCC with MVI. The procedure is associated with high morbidity and mortality and patients' selection is pivotal. Oncological outcomes are safe and should be further investigated.
患有晚期肝细胞癌 (HCC) 和大血管侵犯 (MVI) 的患者预后极差，通常会接受系统治疗或姑息治疗。本研究旨在探讨接受联合肝脏离断和门静脉结扎的分阶段肝切除术 (ALPPS) 的 HCC 合并 MVI 患者的结局。回顾性分析了患者的人口统计学和手术数据。所有类型的肝切除术和所有类型的 ALPPS 改良均包括在内。MVI 根据日本肝癌研究组 (Japanese Liver Cancer Study Group, JLCG) 分类进行分类。共纳入 28 例患者。慢性肝病的最常见病因是病毒性病因 (89.3%)。85.7%的患者为肝硬化，中位 MELD 评分为 9 (7-10)。46.4%的患者诊断为肝静脉或下腔静脉 MVI，64.2%的患者存在门静脉受累。4 例 (14.2%)患者诊断为胆管受累。第 1 步后无患者死亡，但有 21.4%的患者发生并发症。第 2 步后，3 例 (11.5%)患者死亡，20 例 (69.2%)患者发生并发症。术后肝衰竭分级 B 和 C 分别发生在 57.6%和 11.5%的患者中。中位随访 18 个月 (7-35 个月) 后，中位总生存期为 22 个月 (3-40 个月)。11 例患者 (39.3%)复发。无病生存期的中位时间为 15 个月 (5-26 个月)。ALPPS 是一种在无法手术的晚期 HCC 合并 MVI 患者中采用的极端挽救方法。该手术与较高的发病率和死亡率相关，患者的选择至关重要。肿瘤学结局是安全的，应进一步研究。
