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. 2021 Mar 30;19(1):95.
doi: 10.1186/s12957-021-02199-1.

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

Zhenfeng Deng #  1 , Zongrui Jin #  1 , Yonghui Qin  1 , Mingqi Wei  1 , Jilong Wang  1 , Tingting Lu  2 , Ling Zhang  3 , Jingjing Zeng  4 , Li Bao  5 , Ya Guo  1 , Minhao Peng  1 , Banghao Xu  6 , Zhang Wen  7
Affiliations

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

Zhenfeng Deng et al. World J Surg Oncol. .

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.

Keywords: ALPPS; Future liver remnant; Outcomes; Solitary huge hepatocellular carcinoma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Examples of the CT diagram and the IQQA 3D reconstructed model of the liver in patients with solitary huge HCC during perioperation of ALPPS. Abbreviations: CT, computed tomographic; IQQA, intelligent/interactive qualitative and quantitative analyses
Fig. 2
Fig. 2
Relationship of Ishak fibrosis scores and KGR of FLR between the ALPPS-I and the ALPPS-II stages. The median KGR of patients with Ishak fibrosis scores of 1&2, 3&4, and 5&6 were 37.2, 23.2, and 14.6 cm3/day, respectively. The KGR values of patients with Ishak fibrosis scores of 1&2 or 3&4 were significantly higher than those with Ishak fibrosis scores of 5&6 (scores 1&2 vs. 5&6: P = 0.014; scores 3&4 vs. 5&6: P = 0.009). Abbreviations: KGR, kinetic growth rate; FLR, future liver remnant; ALPPS, association liver partition and portal vein ligation for staged hepatectomy
Fig. 3
Fig. 3
Survival analyses of total patients enrolled in this study. No significant difference was observed between ALPPS and one-stage resection patients on (a) the OS (P = 0.770) and (b) the PFS (P = 0.483) rates. However, (a) the OS (P = 0.045) and (b) the PFS (P = 0.034) rates of patients with ALPPS were significantly better than those with TACE. Abbreviations: ALPPS, association liver partition and portal vein ligation for staged hepatectomy; OS, overall survival; PFS, progression-free survival; TACE, transcatheter arterial chemoembolization
Fig. 4
Fig. 4
Survival analyses between ALPPS and the matched one-stage resection groups. No significant difference was observed between the ALPPS and the one-stage resection groups on (a) the OS (P = 0.463) and (b) the PFS (P = 0.786) rates. Abbreviation: ALPPS, association liver partition and portal vein ligation for staged hepatectomy; OS, overall survival; PFS, progression-free survival
Fig. 5
Fig. 5
Survival analyses between ALPPS and the matched TACE groups. a The OS (P = 0.007) and b the PFS (P = 0.011) rates of patients in the ALPPS group were significantly better than those in the TACE group. Abbreviations: ALPPS, association liver partition and portal vein ligation for staged hepatectomy; TACE, transcatheter arterial chemoembolization; OS, overall survival; PFS, progression-free survival
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