Pure Laparoscopic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) for a Giant Hepatocellular Carcinoma (> 15 cm) Abutting the Liver Hilum.

INTRODUCTION

This video manuscript presents a unique case of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure performed in case of a giant hepatocellular carcinoma (> 15 cm in size) whereby both stages were completed via the pure laparoscopic approach.

METHODS

This case was performed in our institution in 2022. All data were obtained from the patient's records in our prospectively maintained database. Institutional Review Board (IRB) was not required for this publication.

RESULTS

A 67-year-old Chinese male with a history of chronic hepatitis B infection presented with a giant liver mass. Magnetic resonance imaging (MRI) scan demonstrated a tumour, with features compatible with hepatocellular carcinoma, measuring 15.4 cm in maximal diameter in the right lobe of the cirrhotic liver with no distal metastasis. The indocyanine green (ICG) retention test at 15 min was prolonged at 25.5%, and the CT volumetry showed a borderline future liver remnant (FLR) volume of 692 ml or 22.9% (based on measured volume) and a standardized FLR of 49%. Stage 1 ALPPS was successfully completed via the pure laparoscopic approach. He was well post-operatively, and a repeat CT volumetry at 7 days showed an increase in FLR to 826 ml, and the ICG retention test improved to 18.1%. The patient underwent pure laparoscopic second-stage ALPPS, 8 days later. The patient recovered well with no liver decompensation or local complications.

CONCLUSION

The use of MIS for in 2-stage ALPPS procedure for giant HCCs larger than 10 cm is technically feasible and safe when attempted in high-volume centres by experienced surgeons, while benefiting from the advantages of MIS liver resection.