Variant ALPPS combined with inferior vena cava reconstruction for end-stage hepatic alveolar echinococcosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TANG Jichao ^1,2 , YANG Chong ² , ZHOU Guo ³ , YANG Hongji ² ,  ZHANG Yu ^1,2 ,  DENG Shaoping ^1,2

1. Clinical Medicine College, Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;
3. Ultrasonic Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;

Corresponding author：

ZHANG Yu, Email: 68532815@qq.com; DENG Shaoping, Email: Sdeng10@163.com

Keywords：

hepatic alveolar echinococcosis; associating liver partition and portal vein ligation for staged hepatectomy; artificial blood vessel; inferior vena cava reconstruction

DOI：

10.7507/1007-9424.202002035

Video：

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Objective To explore the clinical application of variant associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with inferior vena cava reconstruction for end stage hepatic alveolar echinococcosis (HAE).Method The clinical data of one case with HAE who treated in Organ Transplantation Center of Sichuan Provincial People’s Hospital in November 2017 was analyzed retrospectively.Results Computed tomography revealed that the three hepatic veins and retrohepatic inferior vena cava were invaded by multiple and giant hydatid lesions. Only the segment 6 retained the complete portal vein and hepatic vein return branch. Remnant liver volume/standard liver volume (RLV/SLV) of this patient was 24.9%. Surgical exploration was performed after preoperative examination. In the first stage, ligation of the left portal vein and the right anterior lobe portal vein were performed to increase portal blood supply at S6 while partial split of the liver. The patient recovered well after operation without complications such as bile leakage and infection. Six months after the first stage surgery, the second stage surgery was performed, and RLV/SLV measured before surgery was 48.3%. S1–5/S7–8 were completely removed and the hepatic inferior vena cava was reconstructed with artificial blood vessels. The patient was discharged on 10 days after operation, and there was no complications and relapses occurred during the 18 months follow-up period.Conclusions Variant ALPPS combined with inferior vena cava reconstruction is an effective attempt to treat end stage HAE with multiple and giant hydatid lesions and insufficient RLV.

Citation： TANG Jichao, YANG Chong, ZHOU Guo, YANG Hongji, ZHANG Yu, DENG Shaoping. Variant ALPPS combined with inferior vena cava reconstruction for end-stage hepatic alveolar echinococcosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(9): 1139-1144. doi: 10.7507/1007-9424.202002035 Copy

1.	Craig P. Echinococcus multilocularis. Curr Opin Infect Dis, 2003, 16(5): 437-444.
2.	陈哲宇. 肝包虫病的治疗. 中国普外基础与临床杂志, 2015, 22(2): 129-130.
3.	Gruttadauria S, Marsh JW, Bartlett DL, et al. Ex situ resection techniques and liver autotransplantation: last resource for otherwise unresectable malignancy. Dig Dis Sci, 2005, 50(10): 1829-1835.
4.	Li F, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
5.	Haider HH, Nishida S, Selvaggi G, et al. Alveolar Echinococcosis induced liver failure: salvage by liver transplantation in an otherwise uniformly fatal disease. Clin Transplant, 2008, 22(5): 664-667.
6.	Wen H, Dong JH, Zhang JH, et al. ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series. Am J Transplant, 2016, 16(2): 615-624.
7.	王燚, 张宇, 邓绍平, 等. 自体肝移植技术治疗晚期肝泡型包虫病 16 例临床疗效分析. 实用医院临床杂志, 2019, 16(3): 59-63.
8.	Baili E, Tsilimigras DI, Filippou D, et al. Associating liver partition and portal vein ligation for staged hepatectomy in patients with primary liver malignancies: a systematic review of the literature. J BUON, 2019, 24(4): 1371-1381.
9.	Li FG, Yan LN, Li B, et al. Estimation of standard liver volume in Chinese adult living donors. Transplant Proc, 2009, 41(10): 4052-4056.
10.	Maddah G, Abdollahi A, Sharifi-Nooghabi R, et al. Difficulties in the diagnosis and management of alveolar hydatid disease: a case series. Caspian J Intern Med, 2016, 7(1): 52-56.
11.	四川省包虫病诊疗专家组. 四川省肝包虫病诊治规范. 中国普外基础与临床杂志, 2017, 24(7): 798-803.
12.	Mullen JT, Ribero D, Reddy SK, et al. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg, 2007, 204(5): 854-862.
13.	Koch S, Bresson-Hadni S, Miguet JP, et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation, 2003, 75(6): 856-863.
14.	Schreckenbach T, Liese J, Bechstein WO, et al. Posthepatectomy liver failure. Dig Surg, 2012, 29(1): 79-85.
15.	Miyagawa S, Makuuchi M, Kawasaki S, et al. Criteria for safe hepatic resection. Am J Surg, 1995, 169(6): 589-594.
16.	Yigitler C, Farges O, Kianmanesh R, et al. The small remnant liver after major liver resection: how common and how relevant? Liver Transpl, 2003, 9(9): S18-S25.
17.	Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg, 2003, 7(3): 325-330.
18.	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.
19.	de Santibañes E, Clavien PA. Playing Play-Doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg, 2012, 255(3): 415-417.
20.	de Santibañes E, Alvarez FA, Ardiles V. How to avoid postoperative liver failure: a novel method. World J Surg, 2012, 36(1): 125-128.
21.	Serenari M, Zanello M, Schadde E, et al. Importance of primary indication and liver function between stages: results of a multicenter Italian audit of ALPPS 2012-2014. HPB (Oxford), 2016, 18(5): 419-427.
22.	Golriz M, Majlesara A, El Sakka S, et al. Small for Size and Flow (SFSF) syndrome: an alternative description for posthepatectomy liver failure. Clin Res Hepatol Gastroenterol, 2016, 40(3): 267-275.
23.	Moris D, Ronnekleiv-Kelly S, Kostakis ID, et al. Operative results and oncologic outcomes of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) versus two-stage hepatectomy (TSH) in patients with unresectable colorectal liver metastases: a systematic review and meta-analysis. World J Surg, 2018, 42(3): 806-815.
24.	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.
25.	Schadde E, Malagó M, Hernandez-Alejandro R, et al. Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy. Surgery, 2015, 157(4): 676-689.
26.	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.
27.	Broering DC, Hillert C, Krupski G, et al. Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg, 2002, 6(6): 905-913.
28.	Capussotti L, Muratore A, Baracchi F, et al. Portal vein ligation as an efficient method of increasing the future liver remnant volume in the surgical treatment of colorectal metastases. Arch Surg, 2008, 143(10): 978-982.
29.	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.
30.	Alvarez FA, Ardiles V, de Santibañes M, et al. Associating liver partition and portal vein ligation for staged hepatectomy offers high oncological feasibility with adequate patient safety: a prospective study at a single center. Ann Surg, 2015, 261(4): 723-732.
31.	Linecker M, Kambakamba P, Reiner CS, et al. How much liver needs to be transected in ALPPS? A translational study investigating the concept of less invasiveness. Surgery, 2017, 161(2): 453-464.

1. Craig P. Echinococcus multilocularis. Curr Opin Infect Dis, 2003, 16(5): 437-444.
2. 陈哲宇. 肝包虫病的治疗. 中国普外基础与临床杂志, 2015, 22(2): 129-130.
3. Gruttadauria S, Marsh JW, Bartlett DL, et al. Ex situ resection techniques and liver autotransplantation: last resource for otherwise unresectable malignancy. Dig Dis Sci, 2005, 50(10): 1829-1835.
4. Li F, Yang M, Li B, et al. Initial clinical results of orthotopic liver transplantation for hepatic alveolar echinococcosis. Liver Transpl, 2007, 13(6): 924-926.
5. Haider HH, Nishida S, Selvaggi G, et al. Alveolar Echinococcosis induced liver failure: salvage by liver transplantation in an otherwise uniformly fatal disease. Clin Transplant, 2008, 22(5): 664-667.
6. Wen H, Dong JH, Zhang JH, et al. ex vivo liver resection and autotransplantation for end-stage alveolar echinococcosis: a case series. Am J Transplant, 2016, 16(2): 615-624.
7. 王燚, 张宇, 邓绍平, 等. 自体肝移植技术治疗晚期肝泡型包虫病 16 例临床疗效分析. 实用医院临床杂志, 2019, 16(3): 59-63.
8. Baili E, Tsilimigras DI, Filippou D, et al. Associating liver partition and portal vein ligation for staged hepatectomy in patients with primary liver malignancies: a systematic review of the literature. J BUON, 2019, 24(4): 1371-1381.
9. Li FG, Yan LN, Li B, et al. Estimation of standard liver volume in Chinese adult living donors. Transplant Proc, 2009, 41(10): 4052-4056.
10. Maddah G, Abdollahi A, Sharifi-Nooghabi R, et al. Difficulties in the diagnosis and management of alveolar hydatid disease: a case series. Caspian J Intern Med, 2016, 7(1): 52-56.
11. 四川省包虫病诊疗专家组. 四川省肝包虫病诊治规范. 中国普外基础与临床杂志, 2017, 24(7): 798-803.
12. Mullen JT, Ribero D, Reddy SK, et al. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg, 2007, 204(5): 854-862.
13. Koch S, Bresson-Hadni S, Miguet JP, et al. Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report. Transplantation, 2003, 75(6): 856-863.
14. Schreckenbach T, Liese J, Bechstein WO, et al. Posthepatectomy liver failure. Dig Surg, 2012, 29(1): 79-85.
15. Miyagawa S, Makuuchi M, Kawasaki S, et al. Criteria for safe hepatic resection. Am J Surg, 1995, 169(6): 589-594.
16. Yigitler C, Farges O, Kianmanesh R, et al. The small remnant liver after major liver resection: how common and how relevant? Liver Transpl, 2003, 9(9): S18-S25.
17. Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg, 2003, 7(3): 325-330.
18. 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.
19. de Santibañes E, Clavien PA. Playing Play-Doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg, 2012, 255(3): 415-417.
20. de Santibañes E, Alvarez FA, Ardiles V. How to avoid postoperative liver failure: a novel method. World J Surg, 2012, 36(1): 125-128.
21. Serenari M, Zanello M, Schadde E, et al. Importance of primary indication and liver function between stages: results of a multicenter Italian audit of ALPPS 2012-2014. HPB (Oxford), 2016, 18(5): 419-427.
22. Golriz M, Majlesara A, El Sakka S, et al. Small for Size and Flow (SFSF) syndrome: an alternative description for posthepatectomy liver failure. Clin Res Hepatol Gastroenterol, 2016, 40(3): 267-275.
23. Moris D, Ronnekleiv-Kelly S, Kostakis ID, et al. Operative results and oncologic outcomes of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) versus two-stage hepatectomy (TSH) in patients with unresectable colorectal liver metastases: a systematic review and meta-analysis. World J Surg, 2018, 42(3): 806-815.
24. 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.
25. Schadde E, Malagó M, Hernandez-Alejandro R, et al. Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy. Surgery, 2015, 157(4): 676-689.
26. 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.
27. Broering DC, Hillert C, Krupski G, et al. Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg, 2002, 6(6): 905-913.
28. Capussotti L, Muratore A, Baracchi F, et al. Portal vein ligation as an efficient method of increasing the future liver remnant volume in the surgical treatment of colorectal metastases. Arch Surg, 2008, 143(10): 978-982.
29. 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.
30. Alvarez FA, Ardiles V, de Santibañes M, et al. Associating liver partition and portal vein ligation for staged hepatectomy offers high oncological feasibility with adequate patient safety: a prospective study at a single center. Ann Surg, 2015, 261(4): 723-732.
31. Linecker M, Kambakamba P, Reiner CS, et al. How much liver needs to be transected in ALPPS? A translational study investigating the concept of less invasiveness. Surgery, 2017, 161(2): 453-464.

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Variant ALPPS combined with inferior vena cava reconstruction for end-stage hepatic alveolar echinococcosis

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