Efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma with macrovascular invasion: a single-center retrospective analysis

Abstract

Objective The influence of macrovascular invasion on the therapeutic efficacy of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) in hepatocellular carcinoma (HCC) patients has not been previously reported. This study primarily examines the therapeutic effect of ALPPS in treating HCC with macrovascular invasion. Methods 89 patients who underwent ALPPS at the First Affiliated Hospital of Guangxi Medical University from December 2016 to December 2021 were included. Patients were categorized into three groups based on macrovascular invasion status: pure HCC, HCC with portal vein tumor thrombus (PVTT), and HCC with hepatic vein tumor thrombus (HVTT). Outcome measures such as postoperative complications, liver hyperplasia rates, and survival times were compared across the groups. Results The study comprised 44 patients without macrovascular invasion and 45 cases with it, including 37 PVTT and 8 HVTT cases. Patients with PVTT or HVTT had a higher rate of complications and liver failure after the first ALPPS stage compared to those without macrovascular invasion (P = 0.018, P = 0.036). This trend was also observed in the stratified analysis of severe complications. However, no significant differences were found in these outcomes after the second ALPPS stage among the groups. The volume and rate of future liver remnant proliferation between the two stages of ALPPS were not statistically different among the groups, with median overall survival times of 42, 39, and 33 months, and progression-free survival times of 30, 24, and 14 months, respectively (P = 0.412 and P = 0.281). Conclusion ALPPS for HCC with macrovascular invasion was considered safe, feasible, and effective, as it achieved therapeutic effects comparable to those in cases without macrovascular invasion.

Keywords: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS); Efficacy; Hepatocellular carcinoma (HCC); Macrovascular invasion.

Fig. 1

The specific design scheme of this study

Fig. 2

The Surgical Procedure Flowchart. A and B represent the preoperative arterial and venous phase CT scans for a patient undergoing ALPPS, respectively; C, D, E, and F represent the preoperative volume estimation and planning 3D images, which were created using the IQQA 3D imaging system and based on enhanced CT data

Fig. 3

(A) This survival curve illustrated the comparison of postoperative overall survival times among the three patient groups. the log-rank test indicated that the differences were not statistically significant (X² = 0.673, p = 0.412). (B) This survival curve compared the postoperative progression-free survival time among the three patient groups. The log-rank test indicated that the differences were not statistically significant (X² = 1.61, p = 0.281)