Effects Of ALPPS Surgery On Rat Liver Cancer

Background:Liver cancer is one of the most lethal malignancies in the world,and surgical resection is the first and most efficient treatment for liver cancer.However,due to the insidious onset of the disease,most patients are already in the middle and advanced stage when they are found,and miss the opportunity for surgery,resulting in a low resection rate of liver cancer.An important indicator of radical resection is the future liver remnant(FLR),an insufficiency of which can lead to a fatal complication of liver failure.The ratio of FLR/standard liver volume(SLV)needs to be greater than 25%in normal liver patients to avoid complications of postoperative liver failure,and more than 40%in patients with underlying liver disease and cirrhosis Therefore,promoting FLR hyperplasia is an important preliminary work for radical hepatectomy in these patients.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is a surgical procedure accidentally created by Dr.Schlitt in Germany in 2007,summarized and officially named ALPPS by Schnitzbauer et al in 2012.ALPPS surgery can rapidly induce FLR hyperplasia,with 47%-192%of FLR hyperplasia within 1-2 weeks,much higher than previous conventional secondary hepatectomy with PVE or PVL alone.ALPPS surgery not only promotes the rapid regeneration of FLR,but also affects the growth and metastasis of tumors.However,at present,the views of domestic and foreign experts are not consistent,which needs further research to confirm.Objective:To investigate the effect of ALPPS operation on the original tumor and fresh tumor of liver,and the difference between the ligation side and the retained side,so as to provide the basis for clinical decision-making.Methods and results:We first performed ALPPS operation in normal rats to explore a stable and simple method ofALPPS.By measuring the weight of the retained liver,we proved that the established rat ALPPS model is feasible and can promote rapid hyperplasia of the retained liver.Then,Walker-256 cells were used to construct rat liver cancer by tumor mass implantation method,and a single tumor lesion of about 3×3×3mm was formed in rat liver about 7 days.Next,20 SD rats were randomly divided into right middle lobe group(group A,n=10)and left middle lobe group(group B,n=10),and tumors were implanted on corresponding liver lobes of rats.After 7 days later,5 rats in each group were randomly selected to perform ALPPS operation(group Al,group B1),and the other 5 rats perform sham operation(group A2,group B2).After 7 days,the body weight and tumor volume of the rats were calculated The tumor morphology was observed by HE staining,the content of Ki-67 cells was detected by immunohistochemistry,and apoptosis was detected by TUNEL staining.The results showed that the tumor volume of group Al was smaller than that of group A2(P<0.05),and that of group B1 was larger than that of group B2(P>0.05).Finally,another 20 SD rats were selected and randomly divided into right middle lobe group(group C,n=10)and left middle lobe group(group D,n=10).5 rats in each group perform ALPPS operation(group Cl,group D1),and 5 rats perform sham operation(group C2,group D2)immediately after implantation of tumor tissue.The results showed that the tumor volume in group C1 was significantly greater than that in group C2(P<0.05),and there was no difference in the tumor volume between group D1 and group D2(P>0.05).Conclusion:In the retained liver,ALPPS operation inhibited the growth of original tumors and promoted the metastasis and growth of fresh tumors.In the ligation side liver,there was no effect on the growth of the original tumor and fresh tumor.