scholarly journals Case Report: Hepatic Artery Infusion Chemotherapy After Stage I ALPPS in a Patient With Huge HCC

2021 ◽  
Vol 8 ◽  
Author(s):  
Wenfeng Zhuo ◽  
Ang Li ◽  
Weibang Yang ◽  
Jinxin Duan ◽  
Jun Min ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Stage I ◽  
Hepatic Artery Infusion ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Infusion Chemotherapy ◽  
Hepatic Artery Infusion Chemotherapy ◽  
Staged Hepatectomy

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can induce rapid hypertrophy of the liver remnant. However, with a background of liver cirrhosis or other chronic liver diseases, patients with a huge hepatocellular carcinoma (HCC) may sometimes face insufficiency of hepatocellular regeneration after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Herein, we report a 56-year-old male with a vast HCC (13.3 × 8.5 × 13 cm) whose ratio of the future liver remnant (FLR)/standard liver volume (SLV) was 28.7% when the disease was first diagnosed. Inadequate hypertrophy of FLR was shown in postoperative volumetric assessment a month after stage I ALPPS. After multidisciplinary team discussion (MDT), the patient was decided to follow three courses of hepatic arterial infusion chemotherapy (HAIC) with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4). The last HAIC was performed together with transhepatic arterial embolization (TAE). Finally, ratio of the FLR/SLV increased from 28.7% to 40% during three-month intervals, meeting the requirements of the surgery. Stage II ALPPS, right trisectionectomy, was then successfully performed. There was no recurrence at half years of follow-up. In our case, HAIC seems to be more potent than transcatheter arterial chemoembolization (TACE) in maintaining the hyperplasia of the liver remnant, reducing tumor load, and preventing tumor progression in patients with a large HCC during ALPPS procedure. HAIC, following the first step of ALPPS, a pioneering treatment modality aiming for inadequate hypertrophy of FLR induced by ALPPS, could be an alternative procedure for patients with a vast HCC in clinical practice.

scholarly journals ALPPS readdresses the management of advanced liver tumors

2017 ◽  
Vol 4 (3) ◽  
pp. 846 ◽  
Author(s):  
Fa-guang Huang ◽  
Jiang-Hua Xiao ◽  
Jun Kong ◽  
Jian Ping Gong
Keyword(s):  
Portal Vein ◽  
Liver Tumors ◽  
Future Liver Remnant ◽  
Oncological Outcome ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Staged Hepatectomy

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been developed to induce rapid liver hypertrophy of the future liver remnant (FLR) prior to hepatectomy in primarily non-resectable or marginally resectable liver tumors. In recent years, this novel strategy has aroused interests of many liver surgeons. Its indications have been broadened gradually with more and more reported cases. Modified ALPPS is also developed to reduce morbidity and mortality. The authors searched Medline and PubMed to identify related articles published in English, using terms: “ALPPS, associating liver partition and portal vein ligation for staged hepatectomy, in situ split, in situ splitting, liver partition”. The authors summarized and analysed the superiority, indications, modifications, safety, mechanisms of regeneration of ALPPS. ALPPS was more effective than traditional portal vein embolization (PVE) or portal vein ligation (PVL). ALPPS obtained 80% volume increase of future liver remnant (FLR ) within 7 days in contrast to 10%-46% within 2 to 8 weeks by PVE or PVL. ALPPS opens a chapter in the history of liver surgery and readdresses the management of advanced primary and metastatic liver tumors. The high morbidity and mortality associated with ALPPS could be decreased remarkably if we carefully select patients and carry out the operation with experienced surgeons. In addition, the safety, mechanisms and oncological outcome of ALPPS are still not clear, which need further research and randomized controlled trials.

scholarly journals Rapid Induction of Liver Regeneration for Major Hepatectomy (REBIRTH): A Randomized Controlled Trial of Portal Vein Embolisation versus ALPPS Assisted with Radiofrequency

Cancers ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 302 ◽  
Author(s):  
Long Jiao ◽  
Ana Fajardo Puerta ◽  
Tamara Gall ◽  
Mikael Sodergren ◽  
Adam Frampton ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Portal Vein ◽  
Controlled Trial ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Randomized Controlled ◽  
Portal Vein Embolisation ◽  
Number Of Patients

To avoid liver insufficiency following major hepatic resection, portal vein embolisation (PVE) is used to induce liver hypertrophy pre-operatively. Associating liver partition with portal vein ligation for staged hepatectomy assisted with radiofrequency (RALPPS) was introduced as an alternative method. A randomized controlled trial comparing PVE with RALPPS for the pre-operative manipulation of liver volume in patients with a future liver remnant volume (FLRV) ≤25% (or ≤35% if receiving preoperative chemotherapy) was conducted. The primary endpoint was increase in size of the FLRV. The secondary endpoints were length of time taken for the volume gain, morbidity, operation length and post-operative liver function. Between July 2015 and October 2017, 57 patients were randomised to RALPPS (n = 29) and PVE (n = 28). The mean percentage of increase in the FLRV was 80.7 ± 13.7% after a median 20 days following RALPPS compared to 18.4 ± 9.8% after 35 days (p < 0.001) following PVE. Twenty-four patients after RALPPS and 21 after PVE underwent stage-2 operation. Final resection was achieved in 92.3% and 66.6% patients in RALPPS and PVE, respectively (p = 0.007). There was no difference in morbidity, and one 30-day mortality after RALPPS (p = 0.991) was reported. RALPPS is more effective than PVE in increasing FLRV and the number of patients for surgical resection.

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

2020 ◽  
Author(s):  
Quanyu Zhou ◽  
Yuxiao Xia ◽  
Zehua Lei
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Future Liver Remnant ◽  
Postoperative Outcomes ◽  
Postoperative Liver Failure ◽  
Computer Search ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Number Of Patients ◽  
Staged Hepatectomy

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.

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