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. 2022 Feb;11(1):38-51.
doi: 10.21037/hbsn-20-264.

Associating liver partition and portal vein ligation for staged hepatectomy versus sequential transarterial chemoembolization and portal vein embolization in staged hepatectomy for HBV-related hepatocellular carcinoma: a randomized comparative study

Peng-Peng Li #  1 , Gang Huang #  1 , Ning-Yang Jia  1 , Ze-Ya Pan  1 , Hui Liu  1 , Yun Yang  1 , Cheng-Jian He  1 , Wan Yee Lau  2 , Ye-Fa Yang  1 , Wei-Ping Zhou  1
Affiliations

Associating liver partition and portal vein ligation for staged hepatectomy versus sequential transarterial chemoembolization and portal vein embolization in staged hepatectomy for HBV-related hepatocellular carcinoma: a randomized comparative study

Peng-Peng Li et al. Hepatobiliary Surg Nutr. 2022 Feb.

Abstract

Background: Both portal vein embolization (PVE) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) have merits and demerits when used in patients with unresectable liver cancers due to insufficient volumes in future liver remnant (FLR).

Methods: This study was a single-center, prospective randomized comparative study. Patients with the diagnosis of hepatitis B related hepatocellular carcinoma (HCC) were randomly assigned in a 1:1 ratio to the 2 groups. The primary endpoints were tumor resection and three-year overall survival (OS) rates.

Results: Between November 2014 to June 2016, 76 patients with unresectable HBV-related HCC due to inadequate volume of FLR were randomly assigned to ALPPS groups (n=38) and TACE + PVE groups (n=38). Thirty-seven patients (97.4%) in the ALPPS group compared with 25 patients (65.8%) in the TACE + PVE group were able to undergo staged hepatectomy (risk ratio 1.48, 95% CI: 1.17-1.87, P<0.001). The three-year OS rate of the ALPPS group (65.8%) (95% CI: 50.7-80.9) was significantly better than the TACE + PVE group (42.1%) (95% CI: 26.4-57.8) (HR 0.50, 95% CI: 0.26-0.98, two-sided P=0.036). However, no significant difference in the OS rates between patients who underwent tumor resection in the 2 groups of patients was found (HR 0.80, 95% CI: 0.35-1.83, two-sided P=0.595). Major postoperative complications rates after the stage-2 hepatectomy were 54.1% in the ALPPS group and 20.0% in the TACE + PVE group (risk ratio 2.70, 95% CI: 1.17-6.25, P=0.007).

Conclusions: ALPPS resulted in significantly better intermediate-term OS outcomes, at the expenses of a significantly higher perioperative morbidity rate compared with TACE + PVE in patients who had initially unresectable HBV-related HCC.

Keywords: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS); hepatocellular carcinoma (HCC); portal vein embolization (PVE); prognosis; resection rate.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-20-264/coif). WPZ reports grants from NSFC, China, grants from State Key Infection Disease Project of China, grants from National Human Genetic Resources Sharing Service Platform, during the conduct of the study. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of study design. ALPPS, associating liver partition and portal vein ligation for staged hepatectomy; FLR, future liver remnant; TACE, transcatheter arterial chemoembolization; PVE, portal vein embolization.
Figure 2
Figure 2
Liver hypertrophies in different groups. (A) The differences in liver hypertrophy in patients of two groups; (B) volume increase of FLR in patients with different severity of fibrosis and cirrhosis after ALPPS; (C) volume increase of FLR in patients with or without portal hypertension after PVE. ***, P<0.001. FLR, future liver remnant; ALPPS, associating liver partition and portal vein ligation for staged hepatectomy; PVE, portal vein embolization.
Figure 3
Figure 3
Overall survivals between different groups. (A) Comparison of overall survivals between all the patients (including the patients with or without tumor resection) in 2 groups; (B) comparison of overall survivals between the patients who had undergone stage-2 tumor resection in 2 groups; (C) comparison of overall survivals between the patients with and without tumor resection in PVE groups. PVE, portal vein embolization; TACE, transcatheter arterial chemoembolization; ALPPS, associating liver partition and portal vein ligation for staged hepatectomy.
See this image and copyright information in PMC

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References

    1. Ozakyol A. Global Epidemiology of Hepatocellular Carcinoma (HCC Epidemiology). J Gastrointest Cancer 2017;48:238-40. 10.1007/s12029-017-9959-0 - DOI - PubMed
    1. Kawaguchi Y, Honda G, Endo I, et al. Current Technical Issues for Surgery of Primary Liver Cancer. Liver Cancer 2016;6:51-8. 10.1159/000449345 - DOI - PMC - PubMed
    1. She WH. Strategies to increase the resectability of hepatocellular carcinoma. World J Hepatol 2015;7:2147. 10.4254/wjh.v7.i18.2147 - DOI - PMC - PubMed
    1. Kishi Y, Abdalla EK, Chun YS, et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg 2009;250:540-8. 10.1097/SLA.0b013e3181b674df - DOI - PubMed
    1. van Mierlo KMC, Schaap FG, Dejong CHC, et al. Liver resection for cancer: New developments in prediction, prevention and management of postresectional liver failure. J Hepatol 2016;65:1217-31. 10.1016/j.jhep.2016.06.006 - DOI - PubMed

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