Chen Zebin, Shen Shunli, Xie Wenxuan, Liao Junbin, Feng Shiting, Li Shaoqiang, Tan Jiehui, Kuang Ming
Centre of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Department of Diagnostic Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Gastroenterol Rep (Oxf). 2023 Oct 12;11:goad060. doi: 10.1093/gastro/goad060. eCollection 2023.
Insufficient post-operative future liver remnant (FLR) limits the feasibility of hepatectomy for patients. Staged hepatectomy is an effective surgical approach that can improve the resection rate of hepatocellular carcinoma (HCC). This study aimed to compare the safety and efficacy of laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS) and classical associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of hepatitis B virus (HBV)-related HCC.
Clinical data of patients with HBV-related HCC who underwent LAPS or ALPPS in our institute between January 2017 and May 2022 were retrospectively analysed.
A total of 18 patients with HBV-related HCC were retrospectively analysed and divided into the LAPS group (=9) and ALPPS group (=9). Eight patients in the LAPS group and eight patients in the ALPPS group proceeded to a similar resection rate (88.9% vs 88.9%, =1.000). The patients undergoing LAPS had a lower total comprehensive complication index than those undergoing ALPPS but there was not a significant different between the two groups (8.66 vs 35.87, =0.054). The hypertrophy rate of FLR induced by ALPPS tended to be more rapid than that induced by LAPS (24.29 vs 13.17 mL/d, =0.095). The 2-year recurrence-free survival (RFS) was 0% for ALPPS and 35.7% for LAPS (=0.009), whereas the 2-year overall survival for ALPPS and LAPS was 33.3% and 100.0% (=0.052), respectively.
LAPS tended to induce lower morbidity and FLR hypertrophy more slowly than ALPPS, with a comparable resection rate and better long-term RFS in HBV-related HCC patients.
术后未来肝脏残余量（FLR）不足限制了肝癌患者肝切除术的可行性。分期肝切除术是一种有效的手术方法，可提高肝细胞癌（HCC）的切除率。本研究旨在比较腹腔镜微波消融联合门静脉结扎分期肝切除术（LAPS）与经典的联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）在治疗乙型肝炎病毒（HBV）相关HCC中的安全性和疗效。
回顾性分析2017年1月至2022年5月在我院接受LAPS或ALPPS治疗的HBV相关HCC患者的临床资料。
共回顾性分析了18例HBV相关HCC患者，分为LAPS组（n = 9）和ALPPS组（n = 9）。LAPS组8例患者和ALPPS组8例患者的切除率相近（88.9%对88.9%，P = 1.000）。接受LAPS的患者总综合并发症指数低于接受ALPPS的患者，但两组之间无显著差异（8.66对35.87，P = 0.054）。ALPPS诱导的FLR肥大率往往比LAPS诱导的更快（24.29对13.17 mL/d，P = 0.095）。ALPPS组的2年无复发生存率（RFS）为0%，LAPS组为35.7%（P = 0.009），而ALPPS组和LAPS组的2年总生存率分别为33.3%和100.0%（P = 0.052）。
与ALPPS相比，LAPS导致的发病率较低，FLR肥大较慢，在HBV相关HCC患者中切除率相当，长期RFS更好。
