Application of multi-disciplinary team model in associating liver partition and portal vein ligation for staged hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Qujin , LIU Zuojin , TU Bing , GONG Jianping ,  LIU Jiao

Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding author：

LIU Jiao, Email: ljlovey@163.com

Keywords：

multi-disciplinary team model; huge primary liver cancer; associating liver partition and portal vein occlusion for staged hepatectomy

DOI：

10.7507/1007-9424.201802055

Video：

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Objective To explore application value of multi-disciplinary team (MDT) model in patient underwent associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS). Methods A huge mass of liver right lobe about 90.9 mm×75.5 mm×77.5 mm was found by the preoperative abdominal CT examination, which was considered as the primary liver cancer. The ALPPS was decided to perform through the discussion by the Departments of Radiology, Anesthesiology, Infectious disease, Oncology, and Hepatobiliary surgery. The first step operation included the exploratory laparotomy, associating ligation of the right branch of portal vein and disconnection of left and right hemi liver, radiofrequency ablation, and cholecystectomy. The second step operation was performed at 45 d after the first step operation, which included the release of the abdominal adhesion and the resection of the right lobe of liver. Results During the period of the two steps surgeries, though the patient had the liver failure, hepatic encephalopathy, and poor proliferation of the left lobe of liver, and so on, the ALPPS was finished smoothly and the R0 resection was achieved through the collboration of MDT. After the surgery, the related complications were treated by the MDT, the patient got great recovery and no recurrence or metastasis occurred during the following-up. Conclusion It is feasible to use ALPPS in treatment of primary giant liver cancer under MDT model, it will be more conducive to clinical brainstorming for the best treatment and better income of patient.

Citation： LI Qujin, LIU Zuojin, TU Bing, GONG Jianping, LIU Jiao. Application of multi-disciplinary team model in associating liver partition and portal vein ligation for staged hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(7): 852-858. doi: 10.7507/1007-9424.201802055 Copy

1.	曹霖, 汪晓东, 李立. 多学科协作诊治模式的会诊流程探讨(一). 中国普外基础与临床杂志, 2007, 14(3): 343-345.
2.	Kurpad R, Kim W, Rathmell WK, et al. A multidisciplinary approach to the management of urologic malignancies: does it influence diagnostic and treatment decisions? Urol Oncol, 2011, 29(4): 378-382.
3.	徐文杰, 曹刚, 张根山, 等. 聚乙烯醇栓塞微球可载药微球介入治疗中晚期肝癌的临床疗效及安全性观察. 实用癌症杂志, 2017, 32(12): 1999-2001.
4.	Tanaka K, Matsuo K, Murakami T, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity. Eur J Surg Oncol, 2015, 41(4): 506-512.
5.	Schadde E, Raptis DA, Schnitzbauer AA, et al. Prediction of mortality after ALPPS stage-1: an analysis of 320 patients from the International ALPPS Registry. Ann Surg, 2015, 262(5): 780-785.
6.	Bertens KA, Hawel J, Lung K, et al. ALPPS: challenging the concept of unresectability—a systematic review. Int J Surg, 2015, 13: 280-287.
7.	Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): E359-E386.
8.	黄镜. 肝细胞癌免疫治疗进展. 中华医学杂志, 2017, 97(45): 3597-3600.
9.	黄乾荣, 张玲. 原发性肝癌治疗研究新进展. 实用医学杂志, 2016, 32(14): 2275-2278.
10.	Baumgart J, Lang S, Lang H. A new method for induction of liver hypertrophy prior to right trisectioncctomy: a report of three cases. HPB (Oxford), 2011, 13(suppl 2): 1-145.
11.	Schadde E, Ardiles V, Robles-Campos R, et al. Early survival and safety of ALPPS: first report of the International ALPPS Registry. Ann Surg, 2014, 260(5): 829-836.
12.	Croome KP, Hernandez-Alejandro R, Parker M, et al. Is the liver kinetic growth rate in ALPPS unprecedented when compared with PVE and living donor liver transplant? A multicentre analysis. HPB (Oxford), 2015, 17(6): 477-484.
13.	Tanaka K, Matsuo K, Murakami T, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity. Eur J Surg Oncol, 2015, 41(4): 506-512.
14.	Gauzolino R, Castagnet M, Blanleuil ML, et al. The ALPPS technique for bilateral colorectal metastases: three " variations on a theme”. Updates Surg, 2013, 65(2): 141-148.
15.	Gall TM, Sodergren MH, Frampton AE, et al. Radio-frequency-assisted liver partition with portal vein ligation (RALPP) for liver regeneration. Ann Surg, 2015, 261(2): e45-e46.
16.	郑捷. 肝切除术后肝再生调控机制的研究进展. 医学理论与实践, 2014, (18): 2414-2415.
17.	吕璟. 肝再生相关细胞因子的探究. 解剖科学进展, 2005, 11(2): 174-179.
18.	李红蕾, 陈晓光, 张富春, 等. 细胞外基质相关基因在大鼠肝再生中表达模式分析. 遗传, 2008, 30(3): 333-340.
19.	Koniaris LG, McKillop IH, Schwartz SI, et al. Liver regeneration. J Am Coll Surg, 2003, 197(4): 634-659.
20.	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.
21.	Li J, Girotti P, Königsrainer I, et al. ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure? J Gastrointest Surg, 2013, 17(5): 956-961.
22.	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 fight hepatic resection in small-for-size settings. Ann Surg, 2012, 255(3): 405-414．.
23.	黄拼搏, 胡志刚, 许侨东, 等. ALPPS 在具有乙肝肝硬化背景的巨块型肝癌中的应用. 岭南现代临床外科, 2015, 15(5): 527-532.
24.	Chan AC, Poon RT, Chan C, et al. Safety of ALPPS procedure by the anterior approach for hepatocellular carcinoma. Ann Surg, 2016, 263(2): e14-e16.
25.	张金山, 饶丹, 王钢胜. 腹腔镜下 ALPPS 治疗肝癌的临床效果分析. 中华普外科手术学杂志(电子版), 2017, 11(3): 210-213.

1. 曹霖, 汪晓东, 李立. 多学科协作诊治模式的会诊流程探讨(一). 中国普外基础与临床杂志, 2007, 14(3): 343-345.
2. Kurpad R, Kim W, Rathmell WK, et al. A multidisciplinary approach to the management of urologic malignancies: does it influence diagnostic and treatment decisions? Urol Oncol, 2011, 29(4): 378-382.
3. 徐文杰, 曹刚, 张根山, 等. 聚乙烯醇栓塞微球可载药微球介入治疗中晚期肝癌的临床疗效及安全性观察. 实用癌症杂志, 2017, 32(12): 1999-2001.
4. Tanaka K, Matsuo K, Murakami T, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity. Eur J Surg Oncol, 2015, 41(4): 506-512.
5. Schadde E, Raptis DA, Schnitzbauer AA, et al. Prediction of mortality after ALPPS stage-1: an analysis of 320 patients from the International ALPPS Registry. Ann Surg, 2015, 262(5): 780-785.
6. Bertens KA, Hawel J, Lung K, et al. ALPPS: challenging the concept of unresectability—a systematic review. Int J Surg, 2015, 13: 280-287.
7. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): E359-E386.
8. 黄镜. 肝细胞癌免疫治疗进展. 中华医学杂志, 2017, 97(45): 3597-3600.
9. 黄乾荣, 张玲. 原发性肝癌治疗研究新进展. 实用医学杂志, 2016, 32(14): 2275-2278.
10. Baumgart J, Lang S, Lang H. A new method for induction of liver hypertrophy prior to right trisectioncctomy: a report of three cases. HPB (Oxford), 2011, 13(suppl 2): 1-145.
11. Schadde E, Ardiles V, Robles-Campos R, et al. Early survival and safety of ALPPS: first report of the International ALPPS Registry. Ann Surg, 2014, 260(5): 829-836.
12. Croome KP, Hernandez-Alejandro R, Parker M, et al. Is the liver kinetic growth rate in ALPPS unprecedented when compared with PVE and living donor liver transplant? A multicentre analysis. HPB (Oxford), 2015, 17(6): 477-484.
13. Tanaka K, Matsuo K, Murakami T, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity. Eur J Surg Oncol, 2015, 41(4): 506-512.
14. Gauzolino R, Castagnet M, Blanleuil ML, et al. The ALPPS technique for bilateral colorectal metastases: three " variations on a theme”. Updates Surg, 2013, 65(2): 141-148.
15. Gall TM, Sodergren MH, Frampton AE, et al. Radio-frequency-assisted liver partition with portal vein ligation (RALPP) for liver regeneration. Ann Surg, 2015, 261(2): e45-e46.
16. 郑捷. 肝切除术后肝再生调控机制的研究进展. 医学理论与实践, 2014, (18): 2414-2415.
17. 吕璟. 肝再生相关细胞因子的探究. 解剖科学进展, 2005, 11(2): 174-179.
18. 李红蕾, 陈晓光, 张富春, 等. 细胞外基质相关基因在大鼠肝再生中表达模式分析. 遗传, 2008, 30(3): 333-340.
19. Koniaris LG, McKillop IH, Schwartz SI, et al. Liver regeneration. J Am Coll Surg, 2003, 197(4): 634-659.
20. 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.
21. Li J, Girotti P, Königsrainer I, et al. ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure? J Gastrointest Surg, 2013, 17(5): 956-961.
22. 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 fight hepatic resection in small-for-size settings. Ann Surg, 2012, 255(3): 405-414．.
23. 黄拼搏, 胡志刚, 许侨东, 等. ALPPS 在具有乙肝肝硬化背景的巨块型肝癌中的应用. 岭南现代临床外科, 2015, 15(5): 527-532.
24. Chan AC, Poon RT, Chan C, et al. Safety of ALPPS procedure by the anterior approach for hepatocellular carcinoma. Ann Surg, 2016, 263(2): e14-e16.
25. 张金山, 饶丹, 王钢胜. 腹腔镜下 ALPPS 治疗肝癌的临床效果分析. 中华普外科手术学杂志(电子版), 2017, 11(3): 210-213.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of multi-disciplinary team model in associating liver partition and portal vein ligation for staged hepatectomy

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