Liu Gao-Min, Zhang Yao-Min
Department of Hepatobiliary Surgery, Meizhou People's Hospital, Meizhou, China.
Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, China.
Front Surg. 2023 Jan 24;9:920953. doi: 10.3389/fsurg.2022.920953. eCollection 2022.
The future liver remnant (FLR) induced by stage I associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma (HCC) might be limited due to liver fibrosis/cirrhosis or incomplete liver parenchymal transection.
A 51-year-old male with hepatitis B liver fibrosis was diagnosed with a large HCC (13.5 cm × 12.5 cm × 13.8 cm). The FLR of the patient was insufficient to permit one-stage tumor resection. Therefore, the two-stage ALPPS surgery was planned. Stage I ALPPS was performed with incomplete liver parenchymal transection due to bleeding (which is why we called it Mini-ALPPS). On postoperative day (POD) 18, CT revealed that the FLR hypertrophy was poor. The FLR/standard liver volume (SLV) had only increased from 22.00% to 34.63%. Salvage transhepatic arterial chemoembolization (TACE) was performed on POD 22 days to control possible tumor progression during the waiting period and to further facilitate FLR growth. About 16 days later, a CT reassessment of FLR revealed a 42.5% FLR/SLV. A right hepatectomy was then uneventfully performed. Although HCC recurred after 586 days, the patient survived for more than 1,920 days after stage II ALPPS.
Damage control during a difficult conventional stage I ALPPS was important. TACE during the interstage and postoperative periods of this Mini-ALPPS was safe and beneficial. A multidisciplinary based on Mini-ALPPS treatment could provide patients long-term survival; however, Mini-ALPPS should not be selected as the primary solution for such patients today, as some other minimally invasive and effective strategies are available.
在肝细胞癌（HCC）中，用于分期肝切除术的I期联合肝分割和门静脉结扎诱导的未来肝残余（FLR）可能会因肝纤维化/肝硬化或肝实质横断不完全而受限。
一名51岁患有乙型肝炎肝纤维化的男性被诊断为巨大肝细胞癌（13.5 cm×12.5 cm×13.8 cm）。该患者的FLR不足以进行一期肿瘤切除。因此，计划进行两期ALPPS手术。由于出血，I期ALPPS手术时肝实质横断不完全（这就是我们称之为Mini-ALPPS的原因）。术后第18天，CT显示FLR肥大不佳。FLR/标准肝体积（SLV）仅从22.00%增加到34.63%。在术后第22天进行了挽救性经肝动脉化疗栓塞术（TACE），以控制等待期可能的肿瘤进展，并进一步促进FLR生长。约16天后，对FLR进行CT重新评估显示FLR/SLV为42.5%。随后顺利进行了右肝切除术。尽管肝细胞癌在586天后复发，但患者在II期ALPPS术后存活了超过1920天。
在困难的传统I期ALPPS手术中进行损伤控制很重要。在这种Mini-ALPPS的间期和术后进行TACE是安全有益的。基于Mini-ALPPS的多学科治疗可以为患者提供长期生存；然而，如今不应将Mini-ALPPS作为此类患者的首选解决方案，因为还有其他一些微创且有效的策略。
