Conversion hepatectomy for hepatocellular carcinoma with inadequate future- remnant- liver after portal vein ligation in combination with apatinib plus camrelizimab: A single-arm prospective pilot study (PLACES).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16132-e16132
Author(s):  
Zhiming Zeng ◽  
Guangzhi Zhu ◽  
Huasheng Huang ◽  
Yangfeng Jiang ◽  
Xinping Ye ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Hepatic Resection ◽  
Retention Rate ◽  
Objective Response ◽  
Liver Volume ◽  
Portal Vein Ligation ◽  
Remnant Liver ◽  
Future Remnant Liver ◽  
Second Stage

e16132 Background: A variety of staged hepatic resection has been applied in patients (pts) with hepatocellular carcinoma (HCC) who had an inadequate future-remnant-liver (FRL), but the clinical outcomes remain unsatisfactory. Based on the clinical data of apatinib (a highly selective VEGFR-2 inhibitor) and camrelizimab (anti‐PD‐1 antibody) in HCC pts, we therefore evaluated the safety and efficacy of portal vein ligation (PVL) in combination with apatinib plus camrelizimab for primary HCC with insufficient residual liver volume. Methods: Pts aged 18-75, with HCC, Child-Pugh A status, BCLC stage A-C, preoperative indocyanine green retention rate at 15 min < 10%, and preoperative FLR/standardized liver volume (SLV) < 30% (for pts without cirrhosis ) and < 40% (for pts with cirrhosis ) were enrolled. Pts received PVL followed by camrelizimab (200mg, iv, d1 q2w) plus apatinib (250mg, po, pd, q2w) until surgical criteria were met. Pts underwent second-stage hepatic resection 4 weeks after treatment discontinuation, and continued treatment with apatinib plus camrelizimab for 1 year or endpoints occurred. The primary endpoints were resection rate of conversion surgery and ORR (objective response rate). Results: Between Apr 21, 2020 to Jan 20, 2021, 14 pts were enrolled in this trial. The estimated median preoperative FLR/SLV for all pts was 34.6%. Among the 10 evaluable pts, 7 met the criteria for surgery and 5 completed second-stage hepatectomy except for 2 pt who refused and waited for surgery, respectively. The median interval time of the two stages of surgery was 138.8 days. ORR was 40%, and disease control rate (DCR) was 100% (4 pts with partial response and 6 pts with stable disease). The other 4 pts are waiting for the evaluation. No adverse events (AEs) of grade 3 or worse occurred after PVL. The most common treatment-related AEs in pts during treatment with apatinib plus camrelizimab included hypoalbuminemia (36%), increased aspartate aminotransferase (AST) (100%) and rash (29%). Major AEs in pts underoing second-stage hepatectomy were pneumonia (100%), increased AST (100%), increased alanine transaminase (100%) and anemia (100%). One patient died of postoperative pulmonary infection. Conclusions: PVL in combination with apatinib plus camrelizimab followed by staged resection may be a safe and effective treatment option for HCC pts with insufficient FLR. Clinical trial information: ChiCTR2000033692.

scholarly journals Assessment of Liver Function Using 99mTc-Mebrofenin Hepatobiliary Scintigraphy in ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy)

2015 ◽  
Vol 9 (3) ◽  
pp. 353-360 ◽  
Author(s):  
Kasia P. Cieslak ◽  
Pim B. Olthof ◽  
Krijn P. van Lienden ◽  
Marc G. Besselink ◽  
Olivier R.C. Busch ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Volume ◽  
Postoperative Liver Failure ◽  
Portal Vein Ligation ◽  
Hepatobiliary Scintigraphy ◽  
Remnant Liver ◽  
Total Liver Volume ◽  
Second Stage ◽  
Staged Hepatectomy

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a new surgical technique for patients in whom conventional treatment is not feasible due to insufficient future remnant liver (FRL). During the first stage of ALPPS, accelerated hypertrophy of the FRL is induced by ligation of the portal vein and in situ split of the liver. In the second stage, the deportalized liver is removed when the FRL volume has reached ≥25% of total liver volume. However, FRL volume does not necessarily reflect FRL function. 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) with SPECT-CT is a quantitative test enabling regional assessment of parenchymal uptake function using a validated cut-off value for the prediction of postoperative liver failure (2.7%/min/m2). This paper describes the changes in FRL function and FRL volume in a 79-year-old patient diagnosed with metachronous colonic liver metastases who underwent ALPPS. We have observed a substantial difference between the increase in FRL volume and FRL function suggesting that HBS with SPECT-CT enables monitoring of the FRL function and could be a useful tool in the timing of resection in the second stage of the ALPPS procedure.

scholarly journals Preoperative Trans-catheter Arterial Chemoembolization and Laparoscopic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in Unresectable Hepatocellular Carcinoma – A Case Report

BioMedica ◽  
2021 ◽  
Vol 37 (2) ◽  
pp. 86-92
Author(s):  
Yilin Hu ◽  
Yanbing Shen ◽  
Dan Wang ◽  
Tingjia Cao
Keyword(s):  
Hepatocellular Carcinoma ◽  
Case Report ◽  
Portal Vein ◽  
Liver Volume ◽  
Postoperative Outcome ◽  
Portal Vein Ligation ◽  
The Right ◽  
Staged Hepatectomy ◽  
Arterial Chemoembolization

<p>Transcatheter arterial chemoembolization (TACE) is considered as a major method to treat hepatocellular carcinoma (HCC). Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been used to treat patients with advanced HCC. This case report documents the safety, efficacy, and feasibility of TACE and laparoscopic ALPPS to treat the unresectable HCC of the right liver with right intra-hepatic metastasis in a male patient. Percutaneous and trans-femoral artery TACE was performed preoperatively, and the ALPPS stage-I at the 4th week and stage-II after 14 days was carried out. Postoperative outcome was assessed after 180 days of follow-up. It is concluded that preoperative TACE and laparoscopic ALPPS offer a fine treatment alternative to the patients with insufficient residual liver volume and relatively-advanced and extensive HCC.</p>

Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the prospective remnant liver volume 705

2001 ◽  
Vol 120 (5) ◽  
pp. A90
Author(s):  
Christian Hillert ◽  
Dieter C. Broering ◽  
Gerrit Krupski ◽  
Matthias Gundlach ◽  
Xavier Rogiers
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Portal Vein Ligation ◽  
Remnant Liver ◽  
Remnant Liver Volume

scholarly journals Two-stage liver resection for intrahepatic cholangiocarcinoma

2020 ◽  
Vol 25 (1) ◽  
pp. 106-112
Author(s):  
A. V. Chzhao ◽  
B. N. Gurmikov ◽  
V. A. Vishnevsky ◽  
A. A. Olifir ◽  
Ya. Ya. Gavrilov ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Liver Volume ◽  
Liver Parenchyma ◽  
Portal Vein Ligation ◽  
Remnant Liver ◽  
Liver Remnant ◽  
Alternative Version ◽  
The Right ◽  
Cholangiocellular Cancer

The small remnant liver volume remains an urgent problem in liver resection surgery. The use of the method of twostage liver resection – the Associated Liver Partition and Portal vein ligation for Staged hepatectomy in most cases allows to solve this problem. However, this method is associated with a number of complications and limitations. The presented clinical observation shows the effectiveness of an alternative version of this technology – radiofrequency ablation of the liver parenchyma in the plane of the proposed resection with ligation of the right branch of the portal vein to increase the volume of the estimated liver remnant in intrahepatic cholangiocellular cancer.

Multiple utilities of portal vein embolization for patients with hepatocellular carcinoma.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 319-319
Author(s):  
Toru Beppu ◽  
Hirohisa Okabe ◽  
Kazutoshi Okabe ◽  
Toshiro Masuda ◽  
Kosuke Mima ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Disease Free Survival ◽  
Remnant Liver ◽  
Right Hepatectomy ◽  
Tace Group ◽  
Disease Free

319 Background: Portal vein embolization (PVE) is a multi-potential treatment for hepatocellular carcinoma (HCC). The aim of this study is to identify the efficacies of PVE for resectable and unresectable HCC patients. Methods: Until 2011, 668 HCC patients underwent hepatic resection and 102 HCC patients treated with PVE. PVE was performed with percutaneous and ipsilateral approach using ethanolamine oleate iopamidol. Preoperative future remnant liver volume (%LV) and functional liver volume (%FLV ) were assessed with our developed combined 99mTc- galactosyl human serum albumin (GSA) scintigraphy (SPECT)/CT system. In unresectable cases chemoembolization (TACE) was repeated after PVE. Results: 1. Comparison of %LV and %FLV after right-PVE (n=40). %FLV before PVE was significantly lower in PVE group (38%) compared to non-PVE group (58%), but increased remarkably after PVE (from 38% to 55%, P < 0.0001). Right hepatectomy was successfully completed in 10 patients based on %FLV, instead of conventional %LV. 2. Long-term prognosis after right-hepatectomy with /without PVE (n=60). The 3- and 5-year disease-free survival (DFS) rates in the PVE group were significantly greater than those in the non-PVE group (78% and 78% versus 20% and 0%, P = 0.01). The 3- and 5-year overall survival (OS) rates in the PVE group were also higher than those in the non-PVE group (72% and 72% versus 57% and 12%, P <0.05). By multivariate analysis, independent prognostic factors for DFS were application of PVE (HR3.59), Multiple tumor (HR3.57), Fibrosis stage F3–4 (HR2.81), and protein induced by vitamin K absence or antagonists-II (PIVKA-II) ≥678AU/ml (HR2.69). 3. Prevention of intrahepatic metastases in unresectable HCCs in hemi-liver (n=40). The 3-year intrahepatic recurrence rates in the non-portal-embolized area was 58.8% and 81.8%, and the 5-year OS was 38.2% and 8.5%, in the PVE/TACE group and TACE group, respectively. The former rates were sinificantly higher (P<0.05). Conclusions: PVE can improve resectability, and might improve disease-free and overall survival for patients with both resectable and unresectable HCC.

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