Outcome of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) versus portal vein embolisation (PVE) for hepatocellular carcinoma

Abstract

INTRODUCTION: ALPPS has been introduced as a novel procedure to augment future liver remnant (FLR) in patients with marginal liver volume contemplating for major hepatectomy in liver metastasis. There is yet sufficient evidence on the application of ALPPS for hepatitis-related HCC. METHODS: Patients with Child A cirrhosis-related HCC and FLR < 35% of estimated total liver volume (ESLV) contemplating for major hepatectomy were selected for ALPPS. Portal haemodynamics were studied intraoperatively. Postoperative outcomes were compared with PVE (n¼56) matched for age, liver function, and tumor characteristics. RESULTS: From October 2013 to December 2016, 35 patients (hepatitis B, n¼33, hepatitis C, n¼1, steatohepatitis, n¼1) underwent ALPPS. The preoperative FLR/ESLV increased from 26.6% to 37.6% over a median of 6 days with 45.1% actual volume increment. Portal flow to FLR increased from 226.4 ml/min to 557.0 ml/min after in situ split. The time to hepatectomy for ALPPS and PVE were 7 and 48 days (p<0.001). All patients proceeded to stage II operations (right trisectionectomy, n¼5, extended right hepatectomy, n¼10, right hepatectomy: n¼20). ALPPS induced greater FLR hypertrophy rate than PVE (5.1 cc/day vs 0.9 cc/ day, p<0.001) without increased morbidity (8.5% vs 32.1%, p¼0.978) and mortality (8.6% vs 7.1%, p¼1.000). One-year tumor recurrence rate for ALPPS and PVE were similar (TNM I/II: 0% vs 20.5%, p¼0.433, TNM III: 53.8% vs 52.2%, p¼1.000 respectively). CONCLUSIONS: ALPPS is more efficient than PVE in FLR augmentation with similar safety profile and oncological outcome. The entire treatment course, however, could be completed in a timely manner within 1 hospitalization.