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>

Animal Models for Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS): Achievements and Future Perspectives

2017 ◽  
Vol 58 (3-4) ◽  
pp. 140-157 ◽  
Author(s):  
Andras Budai ◽  
Andras Fulop ◽  
Oszkar Hahn ◽  
Peter Onody ◽  
Tibor Kovacs ◽  
...  
Keyword(s):  
Animal Models ◽  
Portal Vein ◽  
Liver Regeneration ◽  
Liver Volume ◽  
Falciform Ligament ◽  
Large Animal ◽  
Portal Vein Ligation ◽  
Total Liver Volume ◽  
The Right ◽  
Staged Hepatectomy

Background: Since 2012, Associated Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has been standing in the limelight of modern liver surgery and numerous questions have been raised regarding this novel approach. On the one hand, ALPPS has proved to be a valuable method in the treatment of hepatic tumors, while on the other hand, there are many controversies, such as high mortality and morbidity rates. Further surgical research is essential for a better understanding of underlying mechanisms and for enhancing patient safety. Summary: Until recently, only 8 animal models have been created with the purpose to mimic ALPPS-induced liver regeneration. From these 7 are rodent (6 rat and 1 mouse) models, while only 1 is a large animal model, which uses pigs. In case of rodent models, portal flow deprivation of 75-90% is achieved via portal vein ligation leaving only the right (20-25%) or left median (10-15%) lobes portally perfused, while liver splitting in general is carried out positioned according to the falciform ligament. As for the swine model, the left lateral and medial lobes (70-75% of total liver volume) are portally ligated, and the right lateral lobe (accounting for 20-24% of the parenchyma) is partially resected in order to reach critical liver volume. Each model is capable of reproducing the accelerated liver regeneration seen in human cases. However, all species have significantly different liver anatomy compared with the human anatomic situation, making clinical translation somewhat difficult. Key Messages: Unfortunately, there are no perfect animal models available for ALPPS research. Small animal models are inexpensive and well suited for basic research, but may only provide limited translational potential to humans. Clinically large animal models may provide more relevant data, but currently no suitable one exists.

Diaphragmatic weakness after transcatheter arterial chemoembolization of the right inferior phrenic artery for treatment of hepatocellular carcinoma: a comparison of outcomes after N-butyl cyanoacrylate versus gelatin sponge embolization

2020 ◽  
pp. 028418512098177
Author(s):  
Seung Yeon Noh ◽  
Dong Il Gwon ◽  
Suyoung Park ◽  
Woo Jin Yang ◽  
Hee Ho Chu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Complete Response ◽  
Gelatin Sponge ◽  
Inferior Phrenic Artery ◽  
Gelatin Sponge Particles ◽  
Phrenic Artery ◽  
The Right ◽  
Diaphragmatic Weakness ◽  
Arterial Chemoembolization

Background The inferior phrenic artery (IPA) is the most common extrahepatic feeder for hepatocellular carcinoma (HCC) during transhepatic arterial chemoembolization (TACE). Purpose To compare the incidence of diaphragmatic weakness in patients with HCC after TACE of the right IPA conducted using either N-butyl cyanoacrylate (NBCA) or gelatin sponge particles. Material and Methods Medical records of 111 patients who underwent TACE of the right IPA using NBCA were retrospectively reviewed and compared with data from 135 patients with IPA embolization using gelatin sponge particles. Results The incidence of diaphragmatic weakness after the initial TACE procedure did not significantly differ between the groups (NBCA group 16.2%; gelatin sponge group 20.7%; P = 0.458). Five patients in the NBCA group and 11 in the gelatin sponge group showed spontaneous resolution of diaphragmatic weakness after a mean period of 3.5 months. Diaphragmatic weakness developed after the initial follow-up visit in 17 patients from the gelatin sponge group due to repeated TACE of the right IPA (mean 2.4 sessions; range 2–4 sessions), while it spontaneously developed without additional TACE procedures in one patient from the NBCA group. Permanent diaphragmatic weakness was less common in the NBCA than in the gelatin sponge group (12.6% and 25.2%, respectively; P = 0.017). The complete response rate did not significantly differ between the groups (NBCA group 16.2%; gelatin sponge group 25.9%; P = 0.065). Conclusion Use of NBCA rather than gelatin sponge particles for TACE of the right IPA resulted in a lower incidence of permanent diaphragmatic weakness.

scholarly journals Dynamic evaluation of liver volume and function in associating liver partition and portal vein ligation for staged hepatectomy

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e130
Author(s):  
E. Sparrelid ◽  
E. Jonas ◽  
A. Tzortzakakis ◽  
U. Dahlén ◽  
G. Murquist ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Volume ◽  
Portal Vein Ligation ◽  
Dynamic Evaluation ◽  
And Function ◽  
Staged Hepatectomy

Associating liver partition and portal vein ligation for staged hepatectomy versus portal vein embolization in staged hepatectomy for hepatocellular carcinoma: A randomized comparative study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4578-4578
Author(s):  
Gang Huang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Portal Vein ◽  
Comparative Study ◽  
Risk Ratio ◽  
Portal Vein Embolization ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Staged Hepatectomy

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 .

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