Analysis of Advantages and Disadvantages of Cirrhotic Patients with Liver Carcinoma by ALPPS (Report of 3 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SUZhi-lei , SHANBa-ga , ZHONGXiang-yu , WANGZhi-dong , LIChun-long , TAISheng ,  CUIYun-fu

Department of General Surgery, The Second Afiliated Hospital, Harbin Medical University, Harbin 150081, Heilongjiang Province, China;

Corresponding author：

CUIYun-fu, Email: yfcui777@hotmail.com

Keywords：

Lliver cirrhosis; Liver cancer; Associating liver partition with portal vein ligation for staged hepatectomy

DOI：

10.7507/1007-9424.20160005

Video：

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Objective To explore it's advantages and disadvantages through analyzed the data of associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) operation in 3 cases of liver cancer patients with cirrhosis. Methods The data of 3 patients perfomed ALPPS operation were retrospectively analyzed, through the preoperative evaluation, intraoperative and postoperative treatment points analyzed to explore the pros and cons. Results One case died of hepatic failure, and the remaining two cases were still alive. The highest score of MELD of liver failure in death case was 18.8 scores, and the other cases of MELD score were decreased after second operation. The average increased volume of liver was 225 mL, and the liver volume was significantly increased (P=0.002). Conclusions ALPPS make a portion of huge liver cancer patients combining with cirrhosis having a chance to surgery. But it is necessary to consider in patients with preoperative state, surgical risk, prognosis and economic conditions,in order to determine whether patients can benefit from ALPPS.

Citation： SUZhi-lei, SHANBa-ga, ZHONGXiang-yu, WANGZhi-dong, LIChun-long, TAISheng, CUIYun-fu. Analysis of Advantages and Disadvantages of Cirrhotic Patients with Liver Carcinoma by ALPPS (Report of 3 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(1): 18-21. doi: 10.7507/1007-9424.20160005 Copy

1.	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.
2.	高杰, 朱继业. 卫生部《原发性肝癌诊疗规范 (2011年版)》解读. 中华普通外科杂志, 2012, 27(8):693-695.
3.	王征, 樊嘉, 周俭. ALPPS 在肝脏外科的应用前景. 肝胆外科杂志, 2015, 23(1):1-2.
4.	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.
5.	赵志惠, 张雷. 肝脏离断和门静脉结扎的二步肝切除术在结直肠癌肝转移治疗中的应用现状. 中华结直肠疾病电子杂志, 2013, 2(5):241-242.
6.	Torres OJ, Moraes-Junior JM, Lima e Lima NC, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS):a new approach in liver resections. Arq Bras Cir Dig, 2012, 25(4):290-292.
7.	刘允怡, 刘晓欣. 对"联合肝脏离断和门静脉结扎的二步肝切除术"的述评. 中华消化外科杂志, 2013, 12(7):481-484.
8.	Dokmak S, Belghiti J. Which limits to the "ALPPS" approach?. Ann Surg, 2012, 256(3):e6.
9.	Tanaka K, Shimada H, Matsuo K, et al. Remnant liver regeneration after two-stage hepatectomy for multiple bilobar colorectal metastases. Eur J Surg Oncol, 2007, 33(3):329-335.
10.	洪德飞, 刘合春, 彭淑牖, 等. 联合肝脏离断和门静脉结扎二步肝切除术治疗肝硬化肝癌疗效分析 (附 1 例报告). 中国实用外科杂志, 2014, 34(8):739-743.
11.	郑树国, 李建伟, 肖乐, 等. 全腹腔镜联合肝脏离断和门静脉结扎的二步肝切除术治疗肝硬化肝癌. 中华消化外科杂志, 2014, 7(13):502-507.
12.	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):866-872.
13.	de Santibañes E, Clavien PA. Playing Play-Doh to prevent posto-perative liver failure:the "ALPPS" approach. Ann Surg, 2012, 255(3):415-417.
14.	Truant S, Oberlin O, Sergent G, et al. Remnant liver volume to body weight ratio≥0.5%:a new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg, 2007, 204(1):22-33.
15.	董家鸿, 郑树森, 陈孝平. 肝切除术前肝脏储备功能评估的专家共识 (2011版). 中华消化外科杂志, 2011, 10(1):20-25.
16.	Adam R, Laurent A, Azoulay D, et al. Two-stage hepatectomy:a planned strategy to treat irresectable liver tumors. Ann Surg, 2000, 232(6):777-785.
17.	Clavien PA, Petrowsky H, Deoliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med, 2007, 356(15):1545-1559.
18.	Andriani OC. Long-term results with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Ann Surg, 2012, 256(3):e5.
19.	Scott M, Baldini G, Fearon K, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1:pathophysiological considerations. Acta Anaesthesiol Scand, 2015, 59(10):1212-1231.
20.	Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery:Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg, 2009, 144(10):961-969.
21.	刘允怡, 赖俊雄, 刘晓欣. 手术切除在肝癌多学科综合治疗中的地位. 中国实用外科杂志, 2014, 34(8):677-680.
22.	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.
23.	Vennarecci G, Laurenzi A, Sandri G L, et al. The ALPPS procedure for hepatocellular carcinoma]. Eur J Surg Oncol, 2014, 40(8):982-988.
24.	Alvarez FA, Ardiles V, Claria RS, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS):tips and tricks. J Gastrointest Surg,2013, 17(4):814-821.
25.	Nadalin S, Capobianco I, Li J, et al. Indications and limits for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Lessons learned from 15 cases at a single centre. Z Gastroenterol, 2014, 52(1):35-42.

1. 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.
2. 高杰, 朱继业. 卫生部《原发性肝癌诊疗规范 (2011年版)》解读. 中华普通外科杂志, 2012, 27(8):693-695.
3. 王征, 樊嘉, 周俭. ALPPS 在肝脏外科的应用前景. 肝胆外科杂志, 2015, 23(1):1-2.
4. 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.
5. 赵志惠, 张雷. 肝脏离断和门静脉结扎的二步肝切除术在结直肠癌肝转移治疗中的应用现状. 中华结直肠疾病电子杂志, 2013, 2(5):241-242.
6. Torres OJ, Moraes-Junior JM, Lima e Lima NC, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS):a new approach in liver resections. Arq Bras Cir Dig, 2012, 25(4):290-292.
7. 刘允怡, 刘晓欣. 对"联合肝脏离断和门静脉结扎的二步肝切除术"的述评. 中华消化外科杂志, 2013, 12(7):481-484.
8. Dokmak S, Belghiti J. Which limits to the "ALPPS" approach?. Ann Surg, 2012, 256(3):e6.
9. Tanaka K, Shimada H, Matsuo K, et al. Remnant liver regeneration after two-stage hepatectomy for multiple bilobar colorectal metastases. Eur J Surg Oncol, 2007, 33(3):329-335.
10. 洪德飞, 刘合春, 彭淑牖, 等. 联合肝脏离断和门静脉结扎二步肝切除术治疗肝硬化肝癌疗效分析 (附 1 例报告). 中国实用外科杂志, 2014, 34(8):739-743.
11. 郑树国, 李建伟, 肖乐, 等. 全腹腔镜联合肝脏离断和门静脉结扎的二步肝切除术治疗肝硬化肝癌. 中华消化外科杂志, 2014, 7(13):502-507.
12. 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):866-872.
13. de Santibañes E, Clavien PA. Playing Play-Doh to prevent posto-perative liver failure:the "ALPPS" approach. Ann Surg, 2012, 255(3):415-417.
14. Truant S, Oberlin O, Sergent G, et al. Remnant liver volume to body weight ratio≥0.5%:a new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg, 2007, 204(1):22-33.
15. 董家鸿, 郑树森, 陈孝平. 肝切除术前肝脏储备功能评估的专家共识 (2011版). 中华消化外科杂志, 2011, 10(1):20-25.
16. Adam R, Laurent A, Azoulay D, et al. Two-stage hepatectomy:a planned strategy to treat irresectable liver tumors. Ann Surg, 2000, 232(6):777-785.
17. Clavien PA, Petrowsky H, Deoliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med, 2007, 356(15):1545-1559.
18. Andriani OC. Long-term results with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Ann Surg, 2012, 256(3):e5.
19. Scott M, Baldini G, Fearon K, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1:pathophysiological considerations. Acta Anaesthesiol Scand, 2015, 59(10):1212-1231.
20. Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery:Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg, 2009, 144(10):961-969.
21. 刘允怡, 赖俊雄, 刘晓欣. 手术切除在肝癌多学科综合治疗中的地位. 中国实用外科杂志, 2014, 34(8):677-680.
22. 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.
23. Vennarecci G, Laurenzi A, Sandri G L, et al. The ALPPS procedure for hepatocellular carcinoma]. Eur J Surg Oncol, 2014, 40(8):982-988.
24. Alvarez FA, Ardiles V, Claria RS, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS):tips and tricks. J Gastrointest Surg,2013, 17(4):814-821.
25. Nadalin S, Capobianco I, Li J, et al. Indications and limits for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Lessons learned from 15 cases at a single centre. Z Gastroenterol, 2014, 52(1):35-42.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of Advantages and Disadvantages of Cirrhotic Patients with Liver Carcinoma by ALPPS (Report of 3 Cases)

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