XING Hongming 1,2 , HUANG Jianhua 1,3 , YOU Xinyu 1,3 , LIAO Yubo 4 , ZHANG Yu 1,2
  • 1. Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;
  • 2. Medical School of University of Electronic Science and Technology of China, Chengdu 610054, P. R. China;
  • 3. Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
  • 4. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, P. R. China;
ZHANG Yu, Email: zhangyuqg@med.uestc.edu.cn
hepatic echinococcosis; liver hydatid disease; portal vein embolization; liver vein deprivation; associating liver partition and portal vein ligation for staged hepatectomy; ALPPS; liver regeneration; two-step hepatectomy
10.7507/1007-9424.202407101
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Objective To explore the safety and efficacy of preoperative liver regeneration and then two-stage liver resection for advanced hepatic alveolar echinococcosis (HAE) patients pre-evaluating insufficient future liver remnant (FLR) after resection. Method The clinical data of the advanced HAE patients who were expected to have insufficient FLR after liver resection and underwent two-step liver resection in the Sichuan Provincial People’s Hospital from December 2016 to December 2022 were retrospectively collected and summarized. Results A total of 11 patients with advanced HAE pathologically confirmed were collected. Among them, 2 cases underwent portal vein embolization (PVE), 2 cases underwent liver vein deprivation (LVD), and 7 cases underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to promote residual liver regeneration in the first stage. The future liver remnant/standard liver volume (FLR/SLV) exceeded the surgical requirement standard of 40%. Then the Ex vivo liver resection combined with autotransplantation, or directly radical liver resection was performed in the second stage. Only one patient underwent surgery to remove packed gauze on day 3 postoperatively due to massive intraoperative bleeding. The median (P25, P75) follow-up time after surgery was 36 (15, 75) months, only one case was found to relapse at the third year after surgery and underwent surgical resection again, and the rest patients had no recurrence, long-term complications, or death. Conclusions Based on the results from these cases, applying PVE, LVD, or ALPPS in the patients with advanced HAE who were expected to have inadequate liver volume after resection aids to residual liver regeneration, creating conditions for the second stage radical resection. The second stage treatment including ex vivo liver resection combined with utotransplantation or directly liver resection could achieve good results and is feasible and safe, which brings a hope for survival for the advanced HAE patients who could not previously undergo curative resection. However, this treatment strategy still incurs high costs and requires further optimization in the future.