Clinical Efficacy Of Associating Liver Partition And Portal Vein Ligation For Staged Hepatectomy In Patients With HBV-related Hepatocellular Carcinoma And Cirrhosis

Objective: China as a big country with a high incidence of hepatitis B virus(HBV).About 70% of Chinese hepatocellular carcinoma(HCC)patients are associated with severe HBV-related cirrhosis,and most of them are diagnosed in the middle or advanced stage.However,only 20%～30% of HCC patients can receive radical surgical treatment.The main limiting factor of radical surgical is insufficient future liver remnant.In recent years,associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is an innovative surgical technique to solve the deficiency of FLR,which can increase future liver remnant to a safe volume in a short-term and achieve the second stage surgery.ALPPS have mostly been used in patients with colorectal liver metastases and rarely reported in HCC patients with severe cirrhosis.In this study,we aim to analyze the clinical data of 54 patients to explore the clinical efficacy of ALPPS in the treatment of HCC patient with HBVrelated cirrhosis.Methods: A retrospective cross-sectional study was conducted.The clinical data of54 HCC patients with HBV-related cirrhosis treated with ALPPS were collected from Fujian Provincial Hospital(28 cases),West China Hospital of Sichuan University(21 cases)and the First Affiliated Hospital of Xiamen University(5 cases)from August 2014 to July 2020.Kaplan-Meier method was used to draw the survival curve and calculate the survival rate.The log-rank test was used to compare the survival time of univariate analysis of variance between groups.The COX proportional hazard model was used in multivariate analysis of variance.Results: Fifty-four patients with HBV-related HCC were included in this study.Nine patients did not meet the criteria of second stage surgery,forty-five patients successfully completed the ALPPS second stage surgery.The median waiting time before ALPPS second stage was 14 days.The median follow-up time of 45 patients underwent ALPPS was 18.2 months,and the OS rates of 45 patients at 1,3,and 5-years were 70.6%,38.4% and 31.7%,respectively.The DFS rates of 45 patients at1,3,and 5-years were 50.5%,22.4% and 19.2%,respectively.The univariate analysis showed that macrovascular invasion(Ma VI)was the adverse prognostic factor for patients with HBV-related HCC after ALPPS(P=0.001).And the multivariate analysis showed that multifocal lesions(P=0.018)and Ma VI(P=0.001)were the prognostic factors for HCC patients who received ALPPS.Conclusion: Liver cirrhosis is not a contraindication in patients with ALPPS,but it may prolong the waiting time for ALPPS second stage.For the patients with multiple intrahepatic tumors or with Ma VI,the indications of ALPPS should be carefully selected.