Two-step liver resection in treatment of advanced hepatic alveolar echinococcosis: Safety and efficacy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

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;

Corresponding author：

ZHANG Yu, Email: zhangyuqg@med.uestc.edu.cn

Keywords：

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

DOI：

10.7507/1007-9424.202407101

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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 FLR/standard liver volume (SLV) exceeded the surgical requirement standard of 40%. Then the ex-vivo liver resection and 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 (approximately 4 000 mL). 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 insufficient FLR after resection aids to residual liver regeneration, creating conditions for the second stage radical resection. The second stage treatment including ex-vivo liver resection and autotransplantation or directly radical liver resection could achieve good results and is feasible and safe, which brings a hope of 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.

Citation： XING Hongming, HUANG Jianhua, YOU Xinyu, LIAO Yubo, ZHANG Yu. Two-step liver resection in treatment of advanced hepatic alveolar echinococcosis: Safety and efficacy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(10): 1202-1209. doi: 10.7507/1007-9424.202407101 Copy

1.	温浩. 包虫病学. 北京: 人民卫生出版社, 2015.
2.	四川省包虫病临床医学研究中心, 四川省医师协会包虫病专业委员会. 泡型肝包虫病诊疗专家共识(2020版). 中国普外基础与临床杂志, 2020, 27(1): 13-17.
3.	王永珍, 韩秀敏, 郭亚民. 肝包虫病的诊断与治疗研究进展. 寄生虫病与感染性疾病, 2018, 16(1): 47-51.
4.	Periago MV. Special issue: “Echinococcosis”. Parasitologia, 2023, 3: 13-14.
5.	Tang JC, Suolang WJ, Yang C, et al. Monosegmental ALPPS combined with ante-situm liver resection: A novel strategy for end-stage hepatic alveolar echinococcosis. Hepatobiliary Pancreat Dis Int, 2022, 21(2): 186-189.
6.	Craig PS, Giraudoux P, Wang ZH, et al. Echinococcosis transmission on the Tibetan Plateau. Adv Parasitol, 2019, 104: 165-246.
7.	张宇, 杨冲, 王燚, 等. 离体肝切除和自体肝移植联合复杂肝静脉重建治疗终末期肝泡型包虫病. 中国普外基础与临床杂志, 2018, 25(10): 1236-1241.
8.	杨文昊, 廖玉波, 黄良, 等. “在体优先”的离体肝切除联合自体肝移植术治疗晚期肝泡型包虫病的应用效果. 中国普外基础与临床杂志, 2022, 29(10): 1308-1312.
9.	Liska V, Treska V, Mírka H, et al. Portal vein embolization—increased chance for liver resecability for malignancies. Rozhl Chir, 2007, 86(2): 97-102.
10.	Amer A, Wilson CH, Manas DM. Liver transplantation for unresectable malignancies: Beyond hepatocellular carcinoma. Eur J Surg Oncol, 2019, 45(12): 2268-2278.
11.	Kawano F, Mise Y, Yamamoto J, et al. Hepatic vein resection and reconstruction for liver malignancies: expanding indication and enhancing parenchyma-sparing hepatectomy. BJS Open, 2021, 5(6): zrab121. doi: 10.1093/bjsopen/zrab121.
12.	中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2019版). 中华消化外科杂志, 2019, 18(8): 711-721.
13.	Maimaitinijiati Y, Meng Y, Chen X. Is long-term follow-up without surgical treatment a valid option for hepatic alveolar echinococcosis?. World J Gastroenterol, 2022, 28(24): 2775-2777.
14.	吐尔干艾力·阿吉, 邵英梅, 赵晋明, 等. 肝泡型包虫病自体肝移植中提升功能肝“量与质”的临床实践: 附12例临床病例分析. 中华医学杂志, 2017, 97(4): 270-275.
15.	胡智明. 肝癌转化治疗策略. 中华肝胆外科杂志, 2023, 29(6): 401-405.
16.	Le Roy B, Gagnière J, Chabrot P, et al. Non-lethal right liver atrophy after TIPS occlusion in A cirrhotic patient: introducing the hepatic biembolization. J Gastrointest Surg, 2016, 20(9): 1671-1672.
17.	Guiu B, Chevallier P, Denys A, et al. Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol, 2016, 26(12): 4259-4267.
18.	Chebaro A, Buc E, Durin T, et al. Liver venous deprivation or associating liver partition and portal vein ligation for staged hepatectomy?: A retrospective multicentric study. Ann Surg, 2021, 274(5): 874-880.
19.	Guiu B, Quenet F, Panaro F, et al. Liver venous deprivation versus portal vein embolization before major hepatectomy: future liver remnant volumetric and functional changes. Hepatobiliary Surg Nutr, 2020, 9(5): 564-576.
20.	Liu T, Huang L, Liu J, et al. Liver vein deprivation combined with two-step hepatectomy for the treatment of advanced hepatic alveolar echinococcosis with remnant liver volume deficiency. Asian J Surg, 2024, 47(5): 2397-2398.
21.	Martin D, Labgaa I, Uldry E, et al. Preoperative liver venous deprivation. Revue Médicale Suisse, 2021, 17(743): 1150-1154.
22.	Oldhafer KJ, Stavrou GA, van Gulik TM, et al. ALPPS—Where do we stand, where do we go?: Eight recommendations from the First International Expert Meeting. Ann Surg, 2016, 263(5): 839-841.
23.	de Santibañes E, Clavien PA. Playing Play-Doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg, 2012, 255(3): 415-417.
24.	Heil J, Korenblik R, Heid F, et al. Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis. Br J Surg, 2021, 108(7): 834-842.
25.	Akbulut S, Cicek E, Kolu M, et al. Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis: First case report in the literature. World J Gastrointest Surg, 2018, 10(1): 1-5.
26.	Schadde E, Malagó M, Hernandez-Alejandro R, et al. Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy. Surgery, 2015, 157(4): 676-689.
27.	唐几超, 杨冲, 周果, 等. 变异ALPPS联合下腔静脉重建治疗晚期肝泡型包虫病. 中国普外基础与临床杂志, 2020, 27(9): 1139-1144.
28.	Matsuo K, Murakami T, Kawaguchi D, et al. Histologic features after surgery associating liver partition and portal vein ligation for staged hepatectomy versus those after hepatectomy with portal vein embolization. Surgery, 2016, 159(5): 1289-1298.
29.	Kambakamba P, Stocker D, Reiner CS, et al. Liver kinetic growth rate predicts postoperative liver failure after ALPPS. HPB (Oxford), 2016, 18(10): 800-805.
30.	廖阳, 李生伟. 联合肝脏离断和门静脉结扎二步肝切除术治疗结直肠癌肝转移的研究现状. 临床肝胆病杂志, 2019, 35(12): 2805-2808.
31.	杨冲, 杨洪吉, 邓绍平, 等. 剩余肝体积不足的晚期肝泡型包虫外科治疗进展. 中国普通外科杂志, 2021, 30(1): 98-104.

1. 温浩. 包虫病学. 北京: 人民卫生出版社, 2015.
2. 四川省包虫病临床医学研究中心, 四川省医师协会包虫病专业委员会. 泡型肝包虫病诊疗专家共识(2020版). 中国普外基础与临床杂志, 2020, 27(1): 13-17.
3. 王永珍, 韩秀敏, 郭亚民. 肝包虫病的诊断与治疗研究进展. 寄生虫病与感染性疾病, 2018, 16(1): 47-51.
4. Periago MV. Special issue: “Echinococcosis”. Parasitologia, 2023, 3: 13-14.
5. Tang JC, Suolang WJ, Yang C, et al. Monosegmental ALPPS combined with ante-situm liver resection: A novel strategy for end-stage hepatic alveolar echinococcosis. Hepatobiliary Pancreat Dis Int, 2022, 21(2): 186-189.
6. Craig PS, Giraudoux P, Wang ZH, et al. Echinococcosis transmission on the Tibetan Plateau. Adv Parasitol, 2019, 104: 165-246.
7. 张宇, 杨冲, 王燚, 等. 离体肝切除和自体肝移植联合复杂肝静脉重建治疗终末期肝泡型包虫病. 中国普外基础与临床杂志, 2018, 25(10): 1236-1241.
8. 杨文昊, 廖玉波, 黄良, 等. “在体优先”的离体肝切除联合自体肝移植术治疗晚期肝泡型包虫病的应用效果. 中国普外基础与临床杂志, 2022, 29(10): 1308-1312.
9. Liska V, Treska V, Mírka H, et al. Portal vein embolization—increased chance for liver resecability for malignancies. Rozhl Chir, 2007, 86(2): 97-102.
10. Amer A, Wilson CH, Manas DM. Liver transplantation for unresectable malignancies: Beyond hepatocellular carcinoma. Eur J Surg Oncol, 2019, 45(12): 2268-2278.
11. Kawano F, Mise Y, Yamamoto J, et al. Hepatic vein resection and reconstruction for liver malignancies: expanding indication and enhancing parenchyma-sparing hepatectomy. BJS Open, 2021, 5(6): zrab121. doi: 10.1093/bjsopen/zrab121.
12. 中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2019版). 中华消化外科杂志, 2019, 18(8): 711-721.
13. Maimaitinijiati Y, Meng Y, Chen X. Is long-term follow-up without surgical treatment a valid option for hepatic alveolar echinococcosis?. World J Gastroenterol, 2022, 28(24): 2775-2777.
14. 吐尔干艾力·阿吉, 邵英梅, 赵晋明, 等. 肝泡型包虫病自体肝移植中提升功能肝“量与质”的临床实践: 附12例临床病例分析. 中华医学杂志, 2017, 97(4): 270-275.
15. 胡智明. 肝癌转化治疗策略. 中华肝胆外科杂志, 2023, 29(6): 401-405.
16. Le Roy B, Gagnière J, Chabrot P, et al. Non-lethal right liver atrophy after TIPS occlusion in A cirrhotic patient: introducing the hepatic biembolization. J Gastrointest Surg, 2016, 20(9): 1671-1672.
17. Guiu B, Chevallier P, Denys A, et al. Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol, 2016, 26(12): 4259-4267.
18. Chebaro A, Buc E, Durin T, et al. Liver venous deprivation or associating liver partition and portal vein ligation for staged hepatectomy?: A retrospective multicentric study. Ann Surg, 2021, 274(5): 874-880.
19. Guiu B, Quenet F, Panaro F, et al. Liver venous deprivation versus portal vein embolization before major hepatectomy: future liver remnant volumetric and functional changes. Hepatobiliary Surg Nutr, 2020, 9(5): 564-576.
20. Liu T, Huang L, Liu J, et al. Liver vein deprivation combined with two-step hepatectomy for the treatment of advanced hepatic alveolar echinococcosis with remnant liver volume deficiency. Asian J Surg, 2024, 47(5): 2397-2398.
21. Martin D, Labgaa I, Uldry E, et al. Preoperative liver venous deprivation. Revue Médicale Suisse, 2021, 17(743): 1150-1154.
22. Oldhafer KJ, Stavrou GA, van Gulik TM, et al. ALPPS—Where do we stand, where do we go?: Eight recommendations from the First International Expert Meeting. Ann Surg, 2016, 263(5): 839-841.
23. de Santibañes E, Clavien PA. Playing Play-Doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg, 2012, 255(3): 415-417.
24. Heil J, Korenblik R, Heid F, et al. Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis. Br J Surg, 2021, 108(7): 834-842.
25. Akbulut S, Cicek E, Kolu M, et al. Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis: First case report in the literature. World J Gastrointest Surg, 2018, 10(1): 1-5.
26. Schadde E, Malagó M, Hernandez-Alejandro R, et al. Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy. Surgery, 2015, 157(4): 676-689.
27. 唐几超, 杨冲, 周果, 等. 变异ALPPS联合下腔静脉重建治疗晚期肝泡型包虫病. 中国普外基础与临床杂志, 2020, 27(9): 1139-1144.
28. Matsuo K, Murakami T, Kawaguchi D, et al. Histologic features after surgery associating liver partition and portal vein ligation for staged hepatectomy versus those after hepatectomy with portal vein embolization. Surgery, 2016, 159(5): 1289-1298.
29. Kambakamba P, Stocker D, Reiner CS, et al. Liver kinetic growth rate predicts postoperative liver failure after ALPPS. HPB (Oxford), 2016, 18(10): 800-805.
30. 廖阳, 李生伟. 联合肝脏离断和门静脉结扎二步肝切除术治疗结直肠癌肝转移的研究现状. 临床肝胆病杂志, 2019, 35(12): 2805-2808.
31. 杨冲, 杨洪吉, 邓绍平, 等. 剩余肝体积不足的晚期肝泡型包虫外科治疗进展. 中国普通外科杂志, 2021, 30(1): 98-104.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Two-step liver resection in treatment of advanced hepatic alveolar echinococcosis: Safety and efficacy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content