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

Bohui LIN; Yimeng OU

doi:10.3969/j.issn.1001-5256.2021.01.039

Volume 37 Issue 1

Jan. 2021

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Abstract

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Article Navigation > Journal of Clinical Hepatology > 2021 > 37(1): 180-183

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

DOI: 10.3969/j.issn.1001-5256.2021.01.039

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510000, China

Received Date: 2020-05-07
Accepted Date: 2020-07-06
Published Date: 2021-01-20

Abstract

Abstract

For hepatocellular carcinoma patients with insufficient residual liver volume, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can achieve the goal of rapidly increasing residual liver volume and removing the tumor, but there are still drawbacks and uncertainties. As a new technique in the field of hepatobiliary surgery, the range of application of ALPPS has been expanded and its technique has been further improved in the past 10 years since its inception. This article summarizes the experience in implementing ALPPS in patients with hepatocellular carcinoma in China and globally, analyzes the key issues of the application of ALPPS in hepatocellular carcinoma patients, and discusses its opportunities and challenges in the era of targeted therapy and immunotherapy.
- Carcinoma, Hepatocellular,
- Hepatectomy,
- Therapeutics

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References(47)

References

[1]	BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. DOI: 10.3322/caac.21492
[2]	AN L, ZENG HM, ZHENG RS, et al. Liver cancer epidemiology in China[J]. Chin J Oncol, 2019, 41(10): 721-727.(in Chinese) 安澜, 曾红梅, 郑荣寿, 等. 2015年中国肝癌流行情况分析[J]. 中华肿瘤杂志, 2019, 41(10): 721-727.
[3]	WANG M, WANG Y, FENG X, et al. Contribution of hepatitis B virus and hepatitis C virus to liver cancer in China north areas: Experience of the Chinese National Cancer Center[J]. Int J Infect Dis, 2017, 65: 15-21. DOI: 10.1016/j.ijid.2017.09.003
[4]	SCHADDE E, ARDILES V, SLANKAMENAC K, et al. ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: Results of a multicenter analysis[J]. World J Surg, 2014, 38(6): 1510-1519. DOI: 10.1007/s00268-014-2513-3
[5]	LINECKER M, STAVROU GA, OLDHAFER KJ, et al. The ALPPS risk score: Avoiding futile use of ALPPS[J]. Ann Surg, 2016, 264(5): 763-771. DOI: 10.1097/SLA.0000000000001914
[6]	LINECKER M, BJÖRNSSON B, STAVROU GA, et al. Risk adjustment in ALPPS is associated with a dramatic decrease in early mortality and morbidity[J]. Ann Surg, 2017, 266(5): 779-786. DOI: 10.1097/SLA.0000000000002446
[7]	de SANTIBAÑES E, CLAVIEN PA. Playing Play-Doh to prevent postoperative liver failure: The "ALPPS" approach[J]. Ann Surg, 2012, 255(3): 415-417. DOI: 10.1097/SLA.0b013e318248577d
[8]	SCHNITZBAUER AA, LANG SA, GOESSMANN H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings[J]. Ann Surg, 2012, 255(3): 405-414. DOI: 10.1097/SLA.0b013e31824856f5
[9]	ZHOU J, WANG Z, SUN J, et al. Associating liver partition and portal vien ligation for staged hepatectomy[J]. Chin J Dig Surg, 2013, 12(7): 485-489. (in Chinese) DOI: 10.3760/cma.j.issn.1673-9752.2013.07.002 周俭, 王征, 孙健, 等. 联合肝脏离断和门静脉结扎的二步肝切除术[J]. 中华消化外科杂志, 2013, 12(7): 485-489. DOI: 10.3760/cma.j.issn.1673-9752.2013.07.002
[10]	OLDHAFER KJ, STAVROU GA, van GULIK TM, et al. ALPPS—Where do we stand, Where do we go? Eight recommendations from the first international expert meeting[J]. Ann Surg, 2016, 263(5): 839-841. DOI: 10.1097/SLA.0000000000001633
[11]	XIANG F, HU ZM. Chance and challenge of associating liver partition and portal vein ligation for staged hepatectomy[J]. Hepatobiliary Pancreat Dis Int, 2019, 18(3): 214-222. DOI: 10.1016/j.hbpd.2019.04.006
[12]	SCHADDE E, ARDILES V, ROBLES-CAMPOS R, et al. Early survival and safety of ALPPS: First report of the International ALPPS Registry[J]. Ann Surg, 2014, 260(5): 829-836; discussion 836-838. DOI: 10.1097/SLA.0000000000000947
[13]	D'HAESE JG, NEUMANN J, WENIGER M, et al. Should ALPPS be used for liver resection in intermediate-stage HCC?[J]. Ann Surg Oncol, 2016, 23(4): 1335-1343. DOI: 10.1245/s10434-015-5007-0
[14]	CHAN AC, POON RT, CHAN C, et al. Safety of ALPPS procedure by the anterior approach for hepatocellular carcinoma[J]. Ann Surg, 2016, 263(2): e14-e16. DOI: 10.1097/SLA.0000000000001272
[15]	WANG Z, PENG Y, HU J, et al. Associating liver partition and portal vein ligation for staged hepatectomy for unresectable hepatitis B virus-related hepatocellular carcinoma: A single center study of 45 patients[J]. Ann Surg, 2020, 271(3): 534-541. DOI: 10.1097/SLA.0000000000002942
[16]	TRUANT S, OBERLIN O, SERGENT G, et al. Remnant liver volume to body weight ratio > or =0.5%: A new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver[J]. J Am Coll Surg, 2007, 204(1): 22-33. DOI: 10.1016/j.jamcollsurg.2006.09.007
[17]	CLAVIEN PA, PETROWSKY H, DEOLIVEIRA ML, et al. Strategies for safer liver surgery and partial liver transplantation[J]. N Engl J Med, 2007, 356(15): 1545-1559. DOI: 10.1056/NEJMra065156
[18]	ESHMUMINOV D, TSCHUOR C, RAPTIS DA, et al. Rapid liver volume increase induced by associating liver partition with portal vein ligation for staged hepatectomy (ALPPS): Is it edema, steatosis, or true proliferation?[J]. Surgery, 2017, 161(6): 1549-1552. DOI: 10.1016/j.surg.2017.01.005
[19]	SHINDOH J, TRUTY MJ, ALOIA TA, et al. Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant[J]. J Am Coll Surg, 2013, 216(2): 201-209. DOI: 10.1016/j.jamcollsurg.2012.10.018
[20]	KAMBAKAMBA P, STOCKER D, REINER CS, et al. Liver kinetic growth rate predicts postoperative liver failure after ALPPS[J]. HPB (Oxford), 2016, 18(10): 800-805. DOI: 10.1016/j.hpb.2016.07.005
[21]	de GRAAF W, van LIENDEN KP, DINANT S, et al. Assessment of future remnant liver function using hepatobiliary scintigraphy in patients undergoing major liver resection[J]. J Gastrointest Surg, 2010, 14(2): 369-378. DOI: 10.1007/s11605-009-1085-2
[22]	TOMASSINI F, D'ASSELER Y, LINECKER M, et al. Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS: A multi-institutional study[J]. HPB (Oxford), 2020.[Online ahead of print]
[23]	AKITA H, SASAKI Y, YAMADA T, et al. Real-time intraoperative assessment of residual liver functional reserve using pulse dye densitometry[J]. World J Surg, 2008, 32(12): 2668-2674. DOI: 10.1007/s00268-008-9752-0
[24]	ZHANG MM, ZHANG LY. Value of indocyanine green clearance test in assessing liver reserve function[J]. J Clin Hepatol, 2019, 35(8): 1878-1881. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.08.052 张明明, 张岭漪. 吲哚菁绿清除试验评估肝储备功能的应用价值[J]. 临床肝胆病杂志, 2019, 35(8): 1878-1881. DOI: 10.3969/j.issn.1001-5256.2019.08.052
[25]	HU ZB, ZHOU X, XIONG Y, et al. Progress in application of indocyanine green scavenging test in liver transplantation patients[J]. Ogran Transplantation, 2019, 7(2): 141-143. (in Chinese) DOI: 10.3969/j.issn.2095-5332.2019.02.017 胡正斌, 周鑫, 熊艳, 等. 吲哚菁绿清除试验在肝移植患者中的应用进展[J]. 器官移植, 2019, 7(2): 141-143. DOI: 10.3969/j.issn.2095-5332.2019.02.017
[26]	RASSAM F, OLTHOF PB, BENNINK RJ, et al. Current modalities for the assessment of future remnant liver function[J]. Visc Med, 2017, 33(6): 442-448. DOI: 10.1159/000480385
[27]	BALZAN S, BELGHITI J, FARGES O, et al. The "50-50 criteria" on postoperative day 5: An accurate predictor of liver failure and death after hepatectomy[J]. Ann Surg, 2005, 242(6): 824-828, discussion 828-829. DOI: 10.1097/01.sla.0000189131.90876.9e
[28]	SCHADDE E, RAPTIS DA, SCHNITZBAUER AA, et al. Prediction of mortality after ALPPS Stage-1: An analysis of 320 patients from the international ALPPS registry[J]. Ann Surg, 2015, 262(5): 780-785; discussion 785-786. DOI: 10.1097/SLA.0000000000001450
[29]	DELIS SG, BAKOYIANNIS A, BILIATIS I, et al. Model for end-stage liver disease (MELD) score, as a prognostic factor for post-operative morbidity and mortality in cirrhotic patients, undergoing hepatectomy for hepatocellular carcinoma[J]. HPB (Oxford), 2009, 11(4): 351-357. DOI: 10.1111/j.1477-2574.2009.00067.x
[30]	PENG C, LI C, LIU C, et al. The outcome of the HCC patients underwent ALPPS: Retrospective study[J]. Medicine (Baltimore), 2019, 98(38): e17182. DOI: 10.1097/MD.0000000000017182
[31]	LIU CH, DENG MW, QIU SY, et al. Analysis of clinical application of ALPPS for hepatocellular carcinoma with mild-to-moderate liver cirrhosis[J]. Chin J Hepatobiliary Surg, 2019, 25(11): 806-808. (in Chinese) 刘春红, 邓明武, 邱思远, 等. ALPPS在合并轻中度肝纤维化肝细胞癌患者中的应用分析[J]. 中华肝胆外科杂志, 2019, 25(11): 806-808.
[32]	CHIA NH, LAI EC, LAU WY. Associating liver partition and portal vein ligation for a patient with hepatocellular carcinoma with a background of hepatitis B related fibrotic liver[J]. Int J Surg Case Rep, 2014, 5(12): 1077-1081. DOI: 10.1016/j.ijscr.2014.11.008
[33]	VENNARECCI G, FERRARO D, TUDISCO A, et al. The ALPPS procedure: Hepatocellular carcinoma as a main indication. An Italian single-center experience[J]. Updates Surg, 2019, 71(1): 67-75. DOI: 10.1007/s13304-018-0596-3
[34]	CHAN A, CHOK K, DAI J, et al. Impact of split completeness on future liver remnant hypertrophy in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma: Complete-ALPPS versus partial-ALPPS[J]. Surgery, 2017, 161(2): 357-364. DOI: 10.1016/j.surg.2016.07.029
[35]	WANG Q, YAN J, FENG X, et al. Safety and efficacy of radiofrequency-assisted ALPPS (RALPPS) in patients with cirrhosis-related hepatocellular carcinoma[J]. Int J Hyperthermia, 2017, 33(7): 846-852. DOI: 10.1080/02656736.2017.1303752
[36]	LÓPEZ-LÓPEZ V, ROBLES-CAMPOS R, BRUSADIN R, et al. Tourniquet-ALPPS is a promising treatment for very large hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. Oncotarget, 2018, 9(46): 28267-28280. DOI: 10.18632/oncotarget.25538
[37]	CAI X, TONG Y, YU H, et al. The ALPPS in the treatment of hepatitis B-related hepatocellular carcinoma with cirrhosis: A single-center study and literature review[J]. Surg Innov, 2017, 24(4): 358-364. DOI: 10.1177/1553350617697187
[38]	MACHADO MA, MAKDISSI FF, SURJAN RC. Totally laparoscopic ALPPS is feasible and may be worthwhile[J]. Ann Surg, 2012, 256(3): e13; author reply e16-e19.
[39]	CAI XJ, PENG SY, YU H, et al. Totally laparoscopic ALPPS for primary liver cancer complicated with cirrhosis-application of; round-the-liver ligation to replace parenchymal transection[J]. Chin J Pract Surg, 2014, 34(7): 637-640. (in Chinese) DOI: 10.7504/CJPS.ISSN1005-2208.2014.07.17 蔡秀军, 彭淑牖, 虞洪, 等. 完全腹腔镜下行ALPPS治疗伴肝硬化的原发性肝癌可行性临床探讨[J]. 中国实用外科杂志, 2014, 34(7): 637-640. DOI: 10.7504/CJPS.ISSN1005-2208.2014.07.17
[40]	WANG Z, ZHOU J. New challenge of liver surgery: Associating liver partition and portal vein ligation for staged hepatectomy[J]. Chin J Dig Surg, 2016, 15(5): 428-430. (in Chinese) DOI: 10.3760/cma.j.issn.1673-9752.2016.05.005 王征, 周俭. 肝脏外科的新挑战:联合肝脏分隔和门静脉结扎的二步肝切除术[J]. 中华消化外科杂志, 2016, 15(5): 428-430. DOI: 10.3760/cma.j.issn.1673-9752.2016.05.005
[41]	VICENTE E, QUIJANO Y, IELPO B, et al. First ALPPS procedure using a total robotic approach[J]. Surg Oncol, 2016, 25(4): 457. DOI: 10.1016/j.suronc.2015.10.001
[42]	FARGES O, BELGHITI J, KIANMANESH R, et al. Portal vein embolization before right hepatectomy[J]. Ann Surg, 2003, 237(2): 208-217. http://gut.bmj.com/external-ref?access_num=12560779&link_type=MED
[43]	CHAN A, ZHANG WY, CHOK K, et al. ALPPS versus portal vein embolization for hepatitis-related hepatocellular carcinoma: A changing paradigm in modulation of future liver remnant before major hepatectomy[J]. Ann Surg, 2019.[Online ahead of print]
[44]	HUANG G. Associating liver partition and portal vein ligation for staged hepatectomy versus portal vein embolization in staged hepatectomy for hepatocellular carcinoma: A randomized comparative study[J]. J Clin Oncol, 2020, 38(15s): 4578.
[45]	KUDO M, FINN RS, QIN S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: A randomised phase 3 non-inferiority trial[J]. Lancet, 2018, 391(10126): 1163-1173. DOI: 10.1016/S0140-6736(18)30207-1
[46]	FINN RS, QIN S, IKEDA M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma[J]. N Engl J Med, 2020, 382(20): 1894-1905. DOI: 10.1056/NEJMoa1915745
[47]	HAN K, KIM JH. Transarterial chemoembolization in hepatocellular carcinoma treatment: Barcelona clinic liver cancer staging system[J]. World J Gastroenterol, 2015, 21(36): 89-97. http://europepmc.org/articles/PMC4579879

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

DOI: 10.3969/j.issn.1001-5256.2021.01.039