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, 陳亞進. 聯合肝臟離斷和門靜脈結扎二步肝切除術幾個焦點問題. 中國實用外科雜志, 2014, 34(8):713-716.
2.	高杰, 朱繼業. 衛生部《原發性肝癌診療規范 (2011年版)》解讀. 中華普通外科雜志, 2012, 27(8):693-695.
3.	王征, 樊嘉, 周儉. ALPPS 在肝臟外科的應用前景. 肝膽外科雜志, 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.	趙志惠, 張雷. 肝臟離斷和門靜脈結扎的二步肝切除術在結直腸癌肝轉移治療中的應用現狀. 中華結直腸疾病電子雜志, 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.	劉允怡, 劉曉欣. 對"聯合肝臟離斷和門靜脈結扎的二步肝切除術"的述評. 中華消化外科雜志, 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.	洪德飛, 劉合春, 彭淑牖, 等. 聯合肝臟離斷和門靜脈結扎二步肝切除術治療肝硬化肝癌療效分析 (附 1 例報告). 中國實用外科雜志, 2014, 34(8):739-743.
11.	鄭樹國, 李建偉, 肖樂, 等. 全腹腔鏡聯合肝臟離斷和門靜脈結扎的二步肝切除術治療肝硬化肝癌. 中華消化外科雜志, 2014, 7(13):502-507.
12.	王志明, 陶一明, 黃云, 等. 聯合肝臟離斷和門靜脈切斷二步肝切除術在肝炎后肝硬化肝癌中的應用]. 中國普通外科雜志, 2014, 23(7):866-872.
13.	de Santiba?es 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.	董家鴻, 鄭樹森, 陳孝平. 肝切除術前肝臟儲備功能評估的專家共識 (2011版). 中華消化外科雜志, 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.	劉允怡, 賴俊雄, 劉曉欣. 手術切除在肝癌多學科綜合治療中的地位. 中國實用外科雜志, 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, 陳亞進. 聯合肝臟離斷和門靜脈結扎二步肝切除術幾個焦點問題. 中國實用外科雜志, 2014, 34(8):713-716.
2. 高杰, 朱繼業. 衛生部《原發性肝癌診療規范 (2011年版)》解讀. 中華普通外科雜志, 2012, 27(8):693-695.
3. 王征, 樊嘉, 周儉. ALPPS 在肝臟外科的應用前景. 肝膽外科雜志, 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. 趙志惠, 張雷. 肝臟離斷和門靜脈結扎的二步肝切除術在結直腸癌肝轉移治療中的應用現狀. 中華結直腸疾病電子雜志, 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. 劉允怡, 劉曉欣. 對"聯合肝臟離斷和門靜脈結扎的二步肝切除術"的述評. 中華消化外科雜志, 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. 洪德飛, 劉合春, 彭淑牖, 等. 聯合肝臟離斷和門靜脈結扎二步肝切除術治療肝硬化肝癌療效分析 (附 1 例報告). 中國實用外科雜志, 2014, 34(8):739-743.
11. 鄭樹國, 李建偉, 肖樂, 等. 全腹腔鏡聯合肝臟離斷和門靜脈結扎的二步肝切除術治療肝硬化肝癌. 中華消化外科雜志, 2014, 7(13):502-507.
12. 王志明, 陶一明, 黃云, 等. 聯合肝臟離斷和門靜脈切斷二步肝切除術在肝炎后肝硬化肝癌中的應用]. 中國普通外科雜志, 2014, 23(7):866-872.
13. de Santiba?es 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. 董家鴻, 鄭樹森, 陳孝平. 肝切除術前肝臟儲備功能評估的專家共識 (2011版). 中華消化外科雜志, 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. 劉允怡, 賴俊雄, 劉曉欣. 手術切除在肝癌多學科綜合治療中的地位. 中國實用外科雜志, 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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