Outcome of ALPPS for Hepatocellular Carcinoma = Outcome of ALPPS for Hepatocellular Carcinoma

다국어 초록 (Multilingual Abstract)

Aims: ALPPS has changed the management of patients with inadequate future liver remnant (FLR) contemplating for major hepatectomy in colorectal metastasis but its efficacy for hepatocellular carcinoma (HCC) in chronic hepatitis/cirrhosis is not substantiated. We hereby reported our experience of ALPPS in hepatitis-related HCC.
Methods: From October 2013 - November 2016, patients with Child A cirrhosis and FLR < 35% of estimated total liver volume (ESLV) were selected for ALPPS. Portal haemodynamic was studied. Postoperative outcome was compared with portal vein embolization (PVE, n=56) matched for age, liver function and tumor characteristics
Results: 36 patients (hepatitis B, n=35; hepatitis C, n=1) underwent ALPPS. Preoperative FLR/ESLV was 24.6% and ICG value was 12.8%. Portal flow to FLR increased from 200.0ml/min to 737.5ml/min after ALPPS. ALPPS induced FLR volume gain by 52.7% in 6 days (post-ALPPS FLR/ESLV = 37.6%) and all patients received stage II operation (right hepatectomy, n =18, extended right hepatectomy, n=11, right trisectionectomy, n=6). The time to hepatectomy for ALPPS and PVE were 7 and 48 days, respectively (p<0.001). ALPPS induced greater FLR hypertrophy than PVE (daily FLR gain: 6.0% vs. 0.8%, p<0.001) without increased morbidity (30.4% vs. 32.1%, p=0.978) and mortality (8.6% vs. 7.1%, p=0.801). 1-year tumor recurrence rate for ALPPS and PVE were similar (TNM I/II: 0% vs. 20.5%, p=0.433; TNM III: 53.8% vs. 52.2%, p=1.000 respectively).
Conclusions: ALPPS induced greater FLR hypertrophy than PVE in chronic liver disease without increased postoperative risk. The entire treatment course was effectively completed within one hospitalization