Comment on “Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Versus Portal Vein Embolization for Hepatitis-related Hepatocellular Carcinoma. A Changing Paradigm in Modulation of Future Liver Remnant Before Major Hepatectomy” by A. Chan, et al

Overall Survival ◽

Portal Vein ◽

Comparative Study ◽

Risk Ratio ◽

Portal Vein Ligation ◽

Liver Remnant ◽

4578 Background: Both Portal Vein Embolization (PVE) and Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) have been used in patients with unresectable hepatocellular carcinoma (HCC) due to insufficient volumes in future liver remnant (FLR). But it remains unclear for which thetapy has better long-term overall survival. Methods: This study was a single-center, prospective randomized comparative study. Patients were randomly assigned in a 1:1 ratio to the 2 groups. The primary endpoints was three-year overall survival rates. Results: Between November 2014 to June 2016, 76 patients with unresectable HCC due to inadequate volume of FLR were randomly assigned to ALPPS groups (n = 38) and PVE groups (n = 38). Thirty-seven patients (97.4%) in the ALPPS Group compared with 25 patients (65.8%) in the PVE Group were able to undergo staged hepatectomy (risk ratio 1.48, 95% CI 1.17-1.87, p < 0.001). The three-year overall survival (OS) rate of the ALPPS group (65.8%) (95% CI 50.7-80.9) was significantly better than the PVE Group (42.1%) (95% CI 26.4-57.8), (HR 0.50, 95% CI 0.26-0.98, two-sided p = 0.036). Major postoperative complications rates after the stage-2 hepatectomy were 54.1% in the ALPPS group and 20.0% in the PVE group ((risk ratio 2.70, 95% CI 1.17-6.25, p = 0.007). Conclusions: ALPPS resulted in significantly better long-term overall survival outcomes, at the expenses of a significantly higher perioperative morbidity rate compared with PVE in patients who had initially unresectable HCC. Clinical trial information: ChiCTR-IOC-14005646 .

Analysis of the Efficacy of Portal Vein Embolization for Patients with Extensive Liver Malignancy and Very Low Future Liver Remnant Volume, Including a Comparison with the Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy Approach

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2013.03.004 ◽

2013 ◽

Vol 217 (1) ◽

pp. 126-133 ◽

Cited By ~ 151

Author(s):

Junichi Shindoh ◽

Jean-Nicolas Vauthey ◽

Giuzeppe Zimmitti ◽

Steven A. Curley ◽

Steven Y. Huang ◽

...

Keyword(s):

Portal Vein ◽

Future Liver Remnant ◽

Portal Vein Ligation ◽

Liver Malignancy ◽

Liver Remnant ◽

Future Liver Remnant Volume ◽

Liver Remnant Volume ◽

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)—pushing the envelope in modulation of future liver remnant before major hepatectomy

HepatoBiliary Surgery and Nutrition ◽

10.21037/hbsn.2019.10.28 ◽

2020 ◽

Vol 9 (1) ◽

pp. 80-82 ◽

Cited By ~ 1

Author(s):

Albert C. Y. Chan ◽

Chung Mau Lo

Keyword(s):

Portal Vein ◽

Major Hepatectomy ◽

Future Liver Remnant ◽

Portal Vein Ligation ◽

Liver Remnant ◽

Comparison of portal vein embolization, portal vein ligation, associating liver partition and portal vein ligation for staged hepatectomy in cases with a small future liver remnant: a network meta-analysis

Translational Cancer Research ◽

10.21037/tcr.2017.08.21 ◽

2017 ◽

Vol 6 (4) ◽

pp. 826-833

Author(s):

Hanchun Huang ◽

Wenjun Liu ◽

Anqiang Wang ◽

Jin Bian ◽

Shanshan Wang ◽

...

Keyword(s):

Portal Vein ◽

Meta Analysis ◽

Future Liver Remnant ◽

Portal Vein Ligation ◽

Liver Remnant ◽

Erratum to comparison of portal vein embolization, portal vein ligation, associating liver partition and portal vein ligation for staged hepatectomy in cases with a small future liver remnant: a network meta-analysis

Translational Cancer Research ◽

10.21037/tcr.2018.01.34 ◽

2018 ◽

Vol 7 (1) ◽

pp. 219-219

Author(s):

Hanchun Huang ◽

Wenju Liu ◽

Anqiang Wang ◽

Jin Bian ◽

Shanshan Wang ◽

...

Keyword(s):

Portal Vein ◽

Meta Analysis ◽

Future Liver Remnant ◽

Portal Vein Ligation ◽

Liver Remnant ◽

The comparison of associating liver partition and portal vein ligation for staged hepatectomy versus portal vein embolization in postoperative outcomes and complications for the treatment of liver cancer with insufficient future liver remnant: a Meta analysis and systematic review

10.21203/rs.3.rs-19920/v1 ◽

2020 ◽

Author(s):

Quanyu Zhou ◽

Yuxiao Xia ◽

Zehua Lei

Keyword(s):

Portal Vein ◽

Future Liver Remnant ◽

Postoperative Outcomes ◽

Postoperative Liver Failure ◽

Computer Search ◽

Portal Vein Ligation ◽

Liver Remnant ◽

Number Of Patients ◽

Abstract Background: This study evaluated the feasibility, safety and effectiveness in patients treated with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and portal vein embolization (PVE) for the treatment of liver malignant tumors with insufficient future liver remnant (FIR). Method: We performed a computer search on the PubMed databases to retrieve the RCT or clinical trials comparing ALPPS and PVE published from January 2010 to January 2020. The quality of the included trials was assessed according to the inclusion and exclusion criteria by two researchers independently. The RevMan 5.3 and STATA 12.0 software were used to extract and analyze the data. Result: A total of 11 retroprospective clinical trial articles comprising 867 patients were included in the study. The number of patients who underwent ALPPS were 247 and 620 for PVE. There were significant differences (P <0.05) in the second stage hepatectomy［OR=11.25, 95%CI: 5.64~22.43, Z=6.87, P＜0.001］, the sufficient FLR growth［MD=46.85, 95% CI:4~89.70, Z=2.41, P=0.03］, the time to stage II operation (MD=-22.85, 95% CI:-33.87~-11.84, Z=4.07, P＜0.001) and rate of R0 resection［OR=2.29, 95%CI: 1.07~4.90, Z=2.13, P=0.03］between the two groups. However, no significant differences were observed between ALPPS and PVE in terms of mortality within 90 days of perioperative period, overall postoperative complication rate, incidence of postoperative liver failure and postoperative hospital stay (P＞0. 05). Conclusion: Compared with PVE, The ALPPS procedure was associated with good postoperative outcomes with insufficient FLR. However, the clinical application of ALPPS and PVE has some limitations. Large, multicenter prospective randomized controlled trials are needed to validate these findings.

Impact of split completeness on future liver remnant hypertrophy in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma: Complete-ALPPS versus partial-ALPPS

Surgery ◽

10.1016/j.surg.2016.07.029 ◽

2017 ◽

Vol 161 (2) ◽

pp. 357-364 ◽

Cited By ~ 21

Author(s):

Albert C.Y. Chan ◽

Kenneth Chok ◽

Jeff W.C. Dai ◽

Chung Mau Lo

Keyword(s):

Portal Vein ◽

Future Liver Remnant ◽

Portal Vein Ligation ◽

Liver Remnant ◽

Sequential Portal Vein Embolization and Percutaneous Radiofrequency Ablation for Future Liver Remnant Growth: A Minimally Invasive Alternative to ALPPS Stage-1 in Treatment of Hepatocellular Carcinoma

Frontiers in Surgery ◽

10.3389/fsurg.2021.741352 ◽

2021 ◽

Vol 8 ◽

Author(s):

Qiang Wang ◽

Yujun Ji ◽

Torkel B. Brismar ◽

Shu Chen ◽

Changfeng Li ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Minimally Invasive ◽

Portal Vein ◽

Good Condition ◽

Future Liver Remnant ◽

Portal Vein Ligation ◽

Liver Remnant ◽

Stage 1

Background: To evaluate the feasibility and efficacy of sequential portal vein embolization (PVE) and radiofrequency ablation (RFA) (PVE+RFA) as a minimally invasive variant for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) stage-1 in treatment of cirrhosis-related hepatocellular carcinoma (HCC).Methods: For HCC patients with insufficient FLR, right-sided PVE was first performed, followed by percutaneous RFA to the tumor as a means to trigger FLR growth. When the FLR reached a safe level (at least 40%) and the blood biochemistry tests were in good condition, the hepatectomy was performed. FLR dynamic changes and serum biochemical tests were evaluated. Postoperative complications, mortality, intraoperative data and long-term oncological outcome were also recorded.Results: Seven patients underwent PVE+RFA for FLR growth between March 2016 and December 2019. The median baseline of FLR was 353 ml (28%), which increased to 539 (44%) ml after 8 (7–18) days of this strategy (p < 0.05). The increase of FLR ranged from 40% to 140% (median 47%). Five patients completed hepatectomy. The median interval between PVE+RFA and hepatectomy was 19 (15–27) days. No major morbidity ≥ III of Clavien-Dindo classification or in-hospital mortality occurred. One patient who did not proceed to surgery died within 90 days after discharge. After a median follow-up of 18 (range 3–50) months, five patients were alive.Conclusion: Sequential PVE+RFA is a feasible and effective strategy for FLR growth prior to extended hepatectomy and may provide a minimally invasive alternative for ALPPS stage-1 for treatment of patients with cirrhosis-related HCC.

Efficacy of the association liver partition and portal vein ligation for staged hepatectomy for the treatment of solitary huge hepatocellular carcinoma: a retrospective single-center study

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02199-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Zhenfeng Deng ◽

Zongrui Jin ◽

Yonghui Qin ◽

Mingqi Wei ◽

Jilong Wang ◽

...

Keyword(s):

Portal Vein ◽

Future Liver Remnant ◽

Portal Vein Ligation ◽

Term Survival ◽

Liver Remnant ◽

One Stage ◽

Maximal Diameter ◽

Huge Hepatocellular Carcinoma ◽

Abstract Background The feasibility of association liver partition and portal vein ligation for staged hepatectomy (ALPPS) for solitary huge hepatocellular carcinoma (HCC, maximal diameter ≥ 10 cm) remains uncertain. This study aims to evaluate the safety and the efficacy of ALPPS for patients with solitary huge HCC. Methods Twenty patients with solitary huge HCC who received ALPPS during January 2017 and December 2019 were retrospectively analyzed. The oncological characteristics of contemporaneous patients who underwent one-stage resection and transcatheter arterial chemoembolization (TACE) were compared using propensity score matching (PSM). Results All patients underwent complete two-staged ALPPS. The median future liver remnant from the ALPPS-I stage to the ALPPS-II stage increased by 64.5% (range = 22.3–221.9%) with a median interval of 18 days (range = 10–54 days). The 90-day mortality rate after the ALPPS-II stage was 5%. The 1- and 3-year overall survival (OS) rates were 70.0% and 57.4%, respectively, whereas the 1- and 3-year progression-free survival (PFS) rates were 60.0% and 43.0%, respectively. In the one-to-one PSM analysis, the long-term survival of patients who received ALPPS was significantly better than those who received TACE (OS, P = 0.007; PFS, P = 0.011) but comparable with those who underwent one-stage resection (OS, P = 0.463; PFS, P = 0.786). Conclusion The surgical outcomes of ALPPS were superior to those of TACE and similar to those of one-stage resection. ALPPS is a safe and effective treatment strategy for patients with unresectable solitary huge HCC.