The Medicine Center of Transplantation, the Second Affiliated Hospital of Guangxi Medical University, Nanning, 530000, China.
The Medical Research Center of Organ Transplantation of Guangxi province, Nanning, 530000, China.
World J Surg Oncol. 2024 Sep 28;22(1):260. doi: 10.1186/s12957-024-03538-8.
Objective The influence of macrovascular invasion on the therapeutic efficacy of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) in hepatocellular carcinoma (HCC) patients has not been previously reported. This study primarily examines the therapeutic effect of ALPPS in treating HCC with macrovascular invasion. Methods 89 patients who underwent ALPPS at the First Affiliated Hospital of Guangxi Medical University from December 2016 to December 2021 were included. Patients were categorized into three groups based on macrovascular invasion status: pure HCC, HCC with portal vein tumor thrombus (PVTT), and HCC with hepatic vein tumor thrombus (HVTT). Outcome measures such as postoperative complications, liver hyperplasia rates, and survival times were compared across the groups. Results The study comprised 44 patients without macrovascular invasion and 45 cases with it, including 37 PVTT and 8 HVTT cases. Patients with PVTT or HVTT had a higher rate of complications and liver failure after the first ALPPS stage compared to those without macrovascular invasion (P = 0.018, P = 0.036). This trend was also observed in the stratified analysis of severe complications. However, no significant differences were found in these outcomes after the second ALPPS stage among the groups. The volume and rate of future liver remnant proliferation between the two stages of ALPPS were not statistically different among the groups, with median overall survival times of 42, 39, and 33 months, and progression-free survival times of 30, 24, and 14 months, respectively (P = 0.412 and P = 0.281). Conclusion ALPPS for HCC with macrovascular invasion was considered safe, feasible, and effective, as it achieved therapeutic effects comparable to those in cases without macrovascular invasion.
目的 大血管侵犯对肝癌患者联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）治疗效果的影响尚未见报道。本研究主要探讨 ALPPS 治疗合并大血管侵犯肝癌的疗效。
方法 回顾性分析 2016 年 12 月至 2021 年 12 月广西医科大学第一附属医院行 ALPPS 的 89 例肝癌患者的临床资料，根据大血管侵犯情况分为单纯肝癌组、肝癌伴门静脉癌栓组（PVTT 组）和肝癌伴肝静脉癌栓组（HVTT 组），比较各组患者术后并发症、肝脏增生率及生存时间等。
结果 89 例患者中，无大血管侵犯 44 例，合并大血管侵犯 45 例，其中合并 PVTT37 例，HVTT8 例。PVTT 或 HVTT 患者第 1 阶段 ALPPS 术后并发症及肝功能衰竭发生率高于无大血管侵犯组（P=0.018，P=0.036），严重并发症的分层分析也存在此趋势，但第 2 阶段 ALPPS 术后各组间差异无统计学意义。各组间 ALPPS 前后 2 个阶段肝脏再生体积和再生率差异均无统计学意义，总生存时间中位数分别为 42、39、33 个月，无进展生存时间中位数分别为 30、24、14 个月（P=0.412，P=0.281）。
结论 合并大血管侵犯的肝癌行 ALPPS 治疗安全、可行、有效，其疗效与无大血管侵犯者相当。
