Radiofrequency-Assisted ALPPS Treatment The Patients with Cirrhosis-Related Primary Hepatocellular Carcinoma: An Initial Report_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANGQiang , YANJun , FENGXiao-bin , CHENGeng , LIXiao-wu , XIAFeng , TANYun-hua , JIANGJia-yun ,  MAKuan-sheng , PIEPing

Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China;

Corresponding author：

MAKuan-sheng, Email: makuansheng@vip.sina.com

Keywords：

Hepatocellular carcinoma; Associating liver partition and portal vein ligation for staged hepatectomy; Radiofrequency ablation; Future liver remnant; Cirrhosis

DOI：

10.7507/1007-9424.20160004

Video：

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Objective To evaluate whether radiofrequency-assisted associating liver partition and portal vein ligation for staged hepatectomy (RALPPS) is a safer and more effective modified treatment for patients with cirrhosis-related hepatocellular carcinoma (HCC). Methods RALPPS were performed in patients with HCC and insufficient volume of future liver remnant (FLR<40%). Data of the patients during perioperative period such as operative morbidity, mortality, operative time, blood loss, percent increase in FLR, and interval between operations, were analyzed to assess the effectiveness and safety of the operation. Results A total of 8 patients were performed the RALPPS operation, and 6 cases completed both stages, 2 cases of postoperative complications or tumor metastasis did not complete the two phase of surgery. The average first and second stages operative time was (214.3±35.7) min, (266.7±46.0) min, respectively, and the average two stages blood loss during the operation was (218.8±113.2) mL,(501.7±224.5) mL, respectively. The mean preoperative FLR was (26.4±7.1)%, and the mean FLR before the second stage was (46.2±4.6)%. The average percentage increase in FLR during the interval time was 35%-113%, and the mean time interval between operations were (22.2±6.4) days. One case died of renal failure and severe pulmonary infection after two operation. Seven patients were followed-up (11.6+2.0) months (8-15 months). Two patients who had not completed the two-stage operation died within 3 months after discharge. Three patients who had completed the two-stage operation were tumor recurrence in 3-9 months after discharged from hospital and supplemented interventional therapy, 1 of them died,and 2 patients were followed-up to now without recurrence. Conclusions RALPPS is equivalent to ALPPS for treating patients with cirrhosis-related HCC and insufficient FLR volume.

Citation： WANGQiang, YANJun, FENGXiao-bin, CHENGeng, LIXiao-wu, XIAFeng, TANYun-hua, JIANGJia-yun, MAKuan-sheng, PIEPing. Radiofrequency-Assisted ALPPS Treatment The Patients with Cirrhosis-Related Primary Hepatocellular Carcinoma: An Initial Report. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(1): 14-17. doi: 10.7507/1007-9424.20160004 Copy

1.	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. Ann Surg, 2012, 255(3):405-414.
2.	de Santibañes E, Clavien PA. Playing Play-Doh to prevent posto-perative liver failure:the "ALPPS" approach. Ann Surg, 2012, 255 (3):415-417.
3.	Alvarez FA, Ardiles V, Sanchez Claria R, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS):tips and tricks. J Gastrointest Surg, 2013, 17(4):814-821.
4.	Schadde E, Ardiles V, Robles-Campos R, et al. Early survival and safety of ALPPS:first report of the International ALPPS Registry. Ann Surg, 2014, 260(5):829-836; discussion 836-828.
5.	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. World J Surg, 2014, 38(6):1510-1519.
6.	Dokmak S, Belghiti J. Which limits to the "ALPPS" approach? Ann Surg, 2012, 256(3):e6; author reply e16-e17.
7.	Gall TM, Sodergren MH, Frampton AE, et al. Radio-frequency-assisted Liver Partition with Portal vein ligation (RALPP) for liver regeneration. Ann Ssurg, 2015, 261(2):e45-e46.
8.	Torres OJ, Fernandes Ede S, Oliveira CV, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS):the Brazilian experience. Arq Bras Cir Dig, 2013, 26(1):40-43.
9.	黎一鸣, 凡吕, 白芝兰, 等. 国人正常肝脏体积计算公式的研究及意义. 陕西医学杂志, 2002, 31(7):634-636.
10.	陈志强. 人体体表面积计算方法的比较研究. 中国运动医学杂志, 2003, 22(6):576-579.
11.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications:five-year experience. Ann Surg, 2009, 250(2):187-196.
12.	Kokudo N,Shindoh J. How can we safely climb the ALPPS? Updates Surg, 2013, 65(3):175-177.
13.	Zhang GQ, Zhang ZW, Lau WY, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS):a new strategy to increase resectability in liver surgery. Int J Surg, 2014, 12(5):437-441.
14.	Li J, Girotti P, Konigsrainer I, et al. ALPPS in right trisectionectomy:a safe procedure to avoid postoperative liver failure. J Gastrointest Surg, 2013, 17(5):956-961.
15.	彭淑牖, 刘允怡, 赖俊雄, 等. 联合肝脏离断和门静脉结扎二步肝切除术在肝癌治疗中应用. 中国实用外科杂志, 2014, 34(8):726-731.
16.	曹君, 陈亚进. 联合肝脏离断和门静脉结扎二步肝切除术几个焦点问题. 中国实用外科杂志, 2014, 34(8):713-716.
17.	Petrowsky H, Györi G, de Oliveira M, et al. Is partial-ALPPS safer than ALPPS? A single-center experience. Ann Surg, 2015, 261(4):e90-e92.
18.	Schlegel A, Lesurtel M, Melloul E, et al. ALPPS:from human to mice highlighting accelerated and novel mechanisms of liver regeneration. Ann Surg, 2014, 260(5):839-846, discussion 846-8437.
19.	Tang TQ, Feng XB, Yan J, et al. Predictive value of indocyanine green retention rate with respect to complications of radiofrequency ablation in 878 patients with hepatocellular carcinoma. Int J Hyperthermia, 2014, 30(6):402-407.
20.	Cai X, Peng S, Duan L, et al. Completely laparoscopic ALPPS using round-the-liver ligation to replace parenchymal transection for a patient with multiple right liver cancers complicated with liver cirrhosis. J Laparoendosc Adv Surg Tech A, 2014, 24(12):883-886.
21.	Vennarecci G, Laurenzi A, Santoro R, et al. The ALPPS procedure:a surgical option for hepatocellular carcinoma with major vascular invasion. World J Surg, 2014, 38(6):1498-1503.
22.	Xiao L, Li JW, Zheng SG. Totally laparoscopic ALPPS in the treat-ment of cirrhotic hepatocellular carcinoma. Surg Endosc, 2015, 29 (9):2800-2801.
23.	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. 中国实用外科杂志, 2014, 34(7):637-640.
24.	刘静, 陈永艺, 曾荣耀, 等. 联合肝脏离断和门静脉结扎的二步肝切除术治疗合并较重肝硬化肝癌1例. 世界华人消化杂志, 2015, 23(6):1038-1044.
25.	王志明, 陶一明, 黄云, 等. 联合肝脏离断和门静脉切断二步肝切除术在肝炎后肝硬化肝癌中的应用. 中国普通外科杂志, 2014, 23(7):867-872.

1. 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. Ann Surg, 2012, 255(3):405-414.
2. de Santibañes E, Clavien PA. Playing Play-Doh to prevent posto-perative liver failure:the "ALPPS" approach. Ann Surg, 2012, 255 (3):415-417.
3. Alvarez FA, Ardiles V, Sanchez Claria R, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS):tips and tricks. J Gastrointest Surg, 2013, 17(4):814-821.
4. Schadde E, Ardiles V, Robles-Campos R, et al. Early survival and safety of ALPPS:first report of the International ALPPS Registry. Ann Surg, 2014, 260(5):829-836; discussion 836-828.
5. 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. World J Surg, 2014, 38(6):1510-1519.
6. Dokmak S, Belghiti J. Which limits to the "ALPPS" approach? Ann Surg, 2012, 256(3):e6; author reply e16-e17.
7. Gall TM, Sodergren MH, Frampton AE, et al. Radio-frequency-assisted Liver Partition with Portal vein ligation (RALPP) for liver regeneration. Ann Ssurg, 2015, 261(2):e45-e46.
8. Torres OJ, Fernandes Ede S, Oliveira CV, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS):the Brazilian experience. Arq Bras Cir Dig, 2013, 26(1):40-43.
9. 黎一鸣, 凡吕, 白芝兰, 等. 国人正常肝脏体积计算公式的研究及意义. 陕西医学杂志, 2002, 31(7):634-636.
10. 陈志强. 人体体表面积计算方法的比较研究. 中国运动医学杂志, 2003, 22(6):576-579.
11. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications:five-year experience. Ann Surg, 2009, 250(2):187-196.
12. Kokudo N,Shindoh J. How can we safely climb the ALPPS? Updates Surg, 2013, 65(3):175-177.
13. Zhang GQ, Zhang ZW, Lau WY, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS):a new strategy to increase resectability in liver surgery. Int J Surg, 2014, 12(5):437-441.
14. Li J, Girotti P, Konigsrainer I, et al. ALPPS in right trisectionectomy:a safe procedure to avoid postoperative liver failure. J Gastrointest Surg, 2013, 17(5):956-961.
15. 彭淑牖, 刘允怡, 赖俊雄, 等. 联合肝脏离断和门静脉结扎二步肝切除术在肝癌治疗中应用. 中国实用外科杂志, 2014, 34(8):726-731.
16. 曹君, 陈亚进. 联合肝脏离断和门静脉结扎二步肝切除术几个焦点问题. 中国实用外科杂志, 2014, 34(8):713-716.
17. Petrowsky H, Györi G, de Oliveira M, et al. Is partial-ALPPS safer than ALPPS? A single-center experience. Ann Surg, 2015, 261(4):e90-e92.
18. Schlegel A, Lesurtel M, Melloul E, et al. ALPPS:from human to mice highlighting accelerated and novel mechanisms of liver regeneration. Ann Surg, 2014, 260(5):839-846, discussion 846-8437.
19. Tang TQ, Feng XB, Yan J, et al. Predictive value of indocyanine green retention rate with respect to complications of radiofrequency ablation in 878 patients with hepatocellular carcinoma. Int J Hyperthermia, 2014, 30(6):402-407.
20. Cai X, Peng S, Duan L, et al. Completely laparoscopic ALPPS using round-the-liver ligation to replace parenchymal transection for a patient with multiple right liver cancers complicated with liver cirrhosis. J Laparoendosc Adv Surg Tech A, 2014, 24(12):883-886.
21. Vennarecci G, Laurenzi A, Santoro R, et al. The ALPPS procedure:a surgical option for hepatocellular carcinoma with major vascular invasion. World J Surg, 2014, 38(6):1498-1503.
22. Xiao L, Li JW, Zheng SG. Totally laparoscopic ALPPS in the treat-ment of cirrhotic hepatocellular carcinoma. Surg Endosc, 2015, 29 (9):2800-2801.
23. 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. 中国实用外科杂志, 2014, 34(7):637-640.
24. 刘静, 陈永艺, 曾荣耀, 等. 联合肝脏离断和门静脉结扎的二步肝切除术治疗合并较重肝硬化肝癌1例. 世界华人消化杂志, 2015, 23(6):1038-1044.
25. 王志明, 陶一明, 黄云, 等. 联合肝脏离断和门静脉切断二步肝切除术在肝炎后肝硬化肝癌中的应用. 中国普通外科杂志, 2014, 23(7):867-872.

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Radiofrequency-Assisted ALPPS Treatment The Patients with Cirrhosis-Related Primary Hepatocellular Carcinoma: An Initial Report

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