Oncological Efficacy of ALPPS for Early-Staged Hepatocellular Carcinoma

Abstract

ALPPS has been advocated for future liver remnant (FLR) augmentation in liver metastasis or non-cirrhotic liver tumors in recent years. Data on the effect of ALPPS in chronic hepatitis or cirrhosis-related early HCC remained scarce. The aim of this study was to evaluate the long-term outcome of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for earlystaged hepatitis-related hepatocellular carcinoma (HCC) in comparison with portal vein embolization (PVE). From 2002 to 2018, 148 patients with HCC (hepatitis B: n = 136, 92.0%) underwent FLR modulation (ALPPS, n = 46; PVE: n = 102). Among those who had resections, 65 patients (56.5%) had cirrhosis. ALPPS induced absolute FLR volume increment by 48.8%, or FLR estimated total liver volume ratio by 12.8% over 6 days. When stratified according to tumor stages, the 1-, 3-, and 5-year OS rates for stage I/II for ALPPS (n = 17) were 81.4%, 69.8%, and 58.2%, and the corresponding rates for PVE (n = 43) were 93%, 85.5%, and 74.5%, respectively (P = 0.183). The 1, 3, and 5-year DFS rates for stage I/II for ALPPS were 81.4%, 54.3%, and 40.7%, and the corresponding rates for PVE were 74.3%, 53.8%, and 53.8% (P = 0.664). In conclusion, ALPPS conferred comparable and long-term oncological outcome with PVE for earlystaged HCC.