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Open Access 01-12-2022 | Hepatocellular Carcinoma | Research

Application of associating liver partition and portal vein ligation for staged hepatectomy for initially unresectable hepatocellular carcinoma

Authors: Haoqi Chen, Xiaowen Wang, Wenfeng Zhu, Yang Li, Zhenyu Yu, Hua Li, Yang Yang, Shuguang Zhu, Xiaolong Chen, Genshu Wang

Published in: BMC Surgery | Issue 1/2022

Abstract

Objective

To evaluate the safety and efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of initially unresectable hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) and to preliminarily explore the mechanism of rapid growth of the future liver remnant (FLR).

Methods

Twenty-four patients with HBV-associated HCC who underwent ALPPS in our hospital from August 2014 to January 2021 were retrospectively studied. Propensity score matching was used to compare oncologic outcomes of patients treated with ALPPS and transarterial chemoembolization (TACE). The expression of YAP and JNK in liver tissue after two stages of ALPPS were detected.

Results

The median standard liver volume (SLV) was 1471.4 ml. Before second stage of ALPPS, the median FLR increased by 74.4%, and the median FLR/SLV increased from 26.1 to 41.6%. Twenty-two patients (91.7%) received staged hepatectomy after a median interval of 15 (9–24) d. The total incidence of postoperative complications in ALPPS group was 54.5%, and of Clavien–Dindo ≥ IIIb postoperative complications (requiring surgical, endoscopic or radiological intervention under general anesthesia) was 9.1%. There was no significant difference in total complications between ALPPS group and TACE group, but there were lower rate of above grade III complications in the TACE group than that in the ALPPS group. The incidence of complications was lower in laparoscopic-ALPPS than that in open surgery. In ALPPS group, the 1-year, 2-year and 5-year overall survival rate were respectively 71.4%, 33.3% and 4.8%. Interval time was an independent risk factor associated with overall survival rate. There was no significant difference in overall survival rate between ALPPS group and TACE group. For advanced HCC (BCLC stage B and C), ALPPS group was not superior to TACE group in overall survival rate. The expression of YAP and p-JNK in the residual liver tissue after second stage procedure was higher than that after first stage procedure, and the co-expression of YAP and p-JNK was observed in the residual liver tissue.

Conclusion

ALPPS is a safe and effective treatment for initially unresectable HBV-associated HCC. Laparoscopic technique might improve the effect of ALPPS. YAP and JNK pathway might take a role in rapid FLR increase in ALPPS procedure.

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Title: Application of associating liver partition and portal vein ligation for staged hepatectomy for initially unresectable hepatocellular carcinoma
Authors: Haoqi Chen
Xiaowen Wang
Wenfeng Zhu
Yang Li
Zhenyu Yu
Hua Li
Yang Yang
Shuguang Zhu
Xiaolong Chen
Genshu Wang
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Hepatocellular Carcinoma
Hepatocellular Carcinoma
Published in: BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-022-01848-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Application of associating liver partition and portal vein ligation for staged hepatectomy for initially unresectable hepatocellular carcinoma

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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