Objective To evaluate the effectiveness and safety of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with laparoscopic-assisted microwave ablation (Lap-MWA) for the liver resection in the treatment of unresectable primary hepatic carcinoma. Methods  This study analyzed the clinical data of 12 hepatic carcinoma patients who underwent ALPPS combined with Lap-MWA for the liver resection from January 2019 to June 2021 in the Department of Hepato-Pancreato-Biliary Surgery of Qinzhou First People’s Hospital. The patients had insufficient future liver remnant (FLR) and different degrees of liver cirrhosis. The 1-stage ALPPS was to perform after the laparoscopic-assisted ligation of the portal vein of the loaded tumor. At the same time, the microwave ablation was used for the liver parenchyma segmentation under the guidance of laparoscopic ultrasound (LUS) without separating liver parenchyma. Other steps were the same as classic ALPPS. Results  All the 12 patients successfully completed the operation. The 1-stage ALPPS lasted 90–130 min, (110.25±35.34) min; the blood loss was 80–140 mL, (100.37±42.24) mL. The interval between 2 stages was 12–16 d, (14.0±2.5) d. The FLR/standard liver volume (SLV) increased to (58.00±3.30) %. The 2-stage ALPPS lasted 120–180 min, (150±30) min; the blood loss was 300–1 200 mL, (453.50±107.70) mL; the hospital stay after 2 stages of ALPPS operations was 11–16 d, (14±2) d. Among all patients, 4 U of leukocyte suspension was transfused in 1 patient, and pleural ascites occurred in 3 patients. There were no serious complications such as liver failure and severe infection, and no death cases. The total hospital stay was 14–22 d, (17±3) d. After the 1-stage ALPPS, the total bilirubin, white blood cells, glutamic-pyruvic transaminase level increased (P＜0.05), and total bilirubin and white blood cells gradually returned to the normal level on the 5^th day after 1-stage ALPPS. On the 1^st day after finishing the 2-stage ALPPS, albumin and hemoglobin decreased, while white blood cells, total bilirubin, prothrombin time and glutamic-pyruvic transaminase increased in varying degrees (P<0.05). And on the 5^th day after the 2-stage ALPPS, all indicators gradually returned to normal. All the patients were followed up for 6–30 months, (20±6) months. Two patients died of tumor recurrence and metastasis at 6.2 months and 13 months after the surgery, respectively. No recurrence was found in other patients, and their life quality was good. Conclusion  Preliminary results of this study indicate that ALPPS combined with Lap-MWA is safe and effective for the treatment of unresectable primary hepatic carcinoma.

Citation： SHOU Zhixiong, ZHENG Dawu, LIANG Yongrong, JIANG Juyi. Clinical observation of laparoscopic-assisted microwave ablation combined withALPPS in the treatment of primary hepatic carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(8): 939-943. doi: 10.7507/1007-9424.202304012 Copy