Clinical Application Of ALPPS In Liver Cirrhosis And Hepatocellular Carcinoma

Background:Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has obtained good application in patients with colorectal liver metastasis with insufficient residual liver volume.In recent years,ALPPS has been used in patients with liver cirrhosis and liver cancer.Some studies have found that the prognosis was improved.However,because cirrhosis affects the regeneration of the liver,some studies showed that the mortality and complications of ALPPS were high.Therefore,the application of ALPPS in liver cirrhosis and liver cancer is still controversial.Objective:The current study aimed to evaluate the feasibility,safety and efficacy of ALPPS for liver cancer with cirrhosis.Materials and methods:A total of 14 ALPPS patients and 21 right hepatectomy(RH)patients were consecutively collected between September 2014 and June 2018 in Peking Union Medical College Hospital.The ALPPS surgery completion rate and remaining liver volume growth rate were analyzed,and factors such as operation time,intraoperative blood loss,survival time,and disease-free survival time were comparatively analyzed.This study also included one patient with caudate lobular liver cancer.The preoperative evaluation,surgical technique,and postoperative follow-up of this patient were analyzed to explore the feasibility of applying ALPPS to patients with caudate lobular liver cancer.Results:14 patients with ALPPS and 21 patients with right hepatectomy had no statistical differences in basic characteristics such as gender,age,tumor size,et al.The FLV/SLV of ALPPS patients was<40%,while the FLV/SLV of right hepatectomy was>40%.For the right hepatic liver cancer,all ALPPS patients had received the second surgery,with 100%resections of R0.The median growth of FLR between operations was 48%in 17 days.3 ALPPS patients suffered from severe complications(grade??b)according to the Clavien-Dindo grade.One of the patients had renal failure,who recovered after dialysis treatment,and 2 patients with FLV/SLV<30%developed liver failure after surgery and died of liver failure after surgery.Only one patient with right hepatectomy had severe complications(liver failure)and died of liver failure two weeks after surgery.In terms of surgery,there was no significant difference in the operation time and blood transfusion between the first step of ALPPS operation and the right hepatectomy.In terms of survival,difference in the long-term survival,either overall survival(OS)or disease-free survival(DFS),between ALPPS and RH was not statistically significant.For the case of caudate lobe liver cancer,the case successfully performed two-step surgery,and postoperative biliary leakage(Clavien-Dindo ?)occurred.There were no serious complications such as bleeding and liver failure during the perioperative period.The patient was followed up for 13 months without tumor recurrence.Conclusions:ALPPS may provide a surgical opportunity for patients with liver cancer of the right half of liver cirrhosis.However,ALPPS should be used with caution in patients with liver cirrhosis and liver cancer with FLR/SLV<30%.ALPPS provides a new surgical scheme for caudate lobe combined with other hepatic lobectomy,which may benefit some patients with caudate lobe liver cancer.