Transcatheter arterial embolization-salvaged ALPPS, a novel ALPPS procedure especially for patients with hepatocellular carcinoma and severe fibrosis/cirrhosis  

作　　者：Yuanfei Peng Zheng Wang Xudong Qu Feiyu Chen Huichuan Sun Xiaoying Wang Zhenbing Ding Min Tang Lei Yu Xinrong Yang Qiang Gao Zhaoyou Tang Wan Yee Lau Jia Fan Jian Zhou 

机构地区：[1]Department of Liver Surgery and Transplantation,Liver Cancer Institute,Zhongshan Hospital,Fudan University,Key Laboratory of Carcinogenesis and Cancer Invasion,Ministry of Education,Fudan University,Shanghai,China [2]Department of Interventional Radiology,Zhongshan Hospital,Fudan University,Shanghai,China [3]Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai,China [4]Faculty of Medicine,The Chinese University of Hong Kong,Prince of Wales Hospital,Shatin,Hong Kong,China [5]Institute of Biomedical Sciences,Fudan University,Shanghai,China [6]State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development,School of Life Sciences,Fudan University,Shanghai,China [7]Shanghai Key Laboratory of Organ Transplantation,Shanghai,China

出　　处：《Hepatobiliary Surgery and Nutrition》2022年第4期504-514,I0001-I0003,共14页肝胆外科与营养（英文）

基　　金：This work was supported by grants from the National Natural Science Foundation of China(No.82150004).

摘　　要：Background:The associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)for hepatocellular carcinoma(HCC)with fibrosis/cirrhosis is often associated with limited growth of future liver remnant(FLR).We introduced a new procedure named transcatheter arterial embolization-salvaged ALPPS(TAE-salvaged ALPPS)which was shown to be especially suitable for HCC patients with cirrhosis or fibrosis who failed adequately to respond to conventional ALPPS.The short-term efficacy and safety for the TAE-salvaged ALPPS on patients with HCC and fibrosis/cirrhosis were studied.Methods:Consecutive HCC patients who underwent TAE-salvaged ALPPS in our hospital between November 2016 and June 2020 were retrospectively studied.The new ALPPS procedure included conventional ALPPS stage-1 using associating liver partition and portal vein ligation.When FLR failed to reach sufficient hypertrophy,TAE was carried out 2 weeks later followed by liver resection 3 weeks after ALPPS stage-1.Results:Nine of 10 patients had a single tumor(median diameter 14.0 cm,range,5.2-17 cm).The remaining patient had multiple tumors(diameter of one tumor 14.0 cm,and two satellite foci 2.0 and 3.0 cm).R0 resection was achieved in all patients(100%)after a median of 21 days.Six patients had cirrhosis,1 had METAVIR grade-3 fibrosis,and 3 had METAVIR grade-2 fibrosis.The median increase in FLR volume after TAE-salvaged ALPPS was 69.7%(34.4-143.9%).The absolute and relative kinetic growth rates(KGRs)were 9.9(7.1-17.3)mL/day and 3.4%(1.9-7.2%)/day,respectively.The median absolute KGRs were 15.7,2.6,and 19.5 mL/day in the first,second,and third postoperative weeks after ALPPS stage-1,respectively.The rapid increase in KGR on the third week was induced by TAE.The overall postoperative morbidity rates were 50,0%(5/10),20.0%(2/10)and 70.0%(7/10)after ALPPS stage-1,TAE and ALPPS stage-2,respectively.The 90-day mortality rate was 10.0%(1/10).The median overall survival was 40 months.Conclusions:The new TAE-salvaged ALPPS induced significant increases i

关 键 词：Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) transcatheter arterial embolization(TAE) hepatocellular carcinoma(HCC) CIRRHOSIS FIBROSIS 

分 类 号：R735.7[医药卫生—肿瘤] R575.2[医药卫生—临床医学]