MDT discussion of a case of intraperitoneal mass after associating liver partition and portal vein ligation for staged hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CAO Heng ¹ , LI Jian ¹ , WANG Jilong ¹ , ZHU Hai ¹ , XU Banghao ¹ , GUO Ya ¹ , TENG Yanjuan ¹ , PENG Tao ¹ , PENG Minhao ¹ , LIAO Jinyuan ² , YANG Hong ³ , ZHOU Shengsheng ⁴ , HU Kai ⁵ , LIANG Zhihai ⁶ ,  WEN Zhang ¹

1. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;
2. Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;
3. Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;
4. Department of Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;
5. Department of Radiotherapy, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;
6. Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, P. R. China;

Corresponding author：

WEN Zhang, Email: wenzgxmu@163.com

Keywords：

hepatocellular carcinoma; associating liver partition and portal vein ligation for staged hepatectomy; intraperitoneal mass; multidisciplinary team

DOI：

10.7507/1007-9424.202103082

Video：

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Objective To summarize experiences of diagnosis and treatment of intraperitoneal mass after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in treatment of hepatocellular carcinoma (HCC).Method The clinicopathologic data of a 40 years old case of HCC with intraperitoneal mass after ALPPS in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed.Results The patient was admitted to this hospital because of abdominal pain and abdominal distension for 5 d. The intraperitoneal mass was found and its nature was not clear on year 1 after ALPPS on admission. After discussion of multidisciplinary team (MDT), the exploratory laparotomy and abdominal tumor resection were planned to perform. The intraperitoneal mass and appendix were removed, the resected tissues were diagnosed as chronic inflammation and retroperitoneal abscess caused by perforation of suppurative appendicitis, respectively. The anti-infection and symptomatic support treatment were strengthened to perform after operation, the patient discharged after recovery. The patient was followed up so far, the general condition was good, and there was no clinical recurrence.Conclusions For patient underwent ALPPS, regular follow-up should be paid attention to. If intraperitoneal mass is found and nature is not clear, MDT discussion should be performed so as to make a more reasonable treatment plan. After exclusion of contraindications, surgical treatment should be carried out to furthest benefit patients.

Citation： CAO Heng, LI Jian, WANG Jilong, ZHU Hai, XU Banghao, GUO Ya, TENG Yanjuan, PENG Tao, PENG Minhao, LIAO Jinyuan, YANG Hong, ZHOU Shengsheng, HU Kai, LIANG Zhihai, WEN Zhang. MDT discussion of a case of intraperitoneal mass after associating liver partition and portal vein ligation for staged hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(7): 930-936. doi: 10.7507/1007-9424.202103082 Copy

1.	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.
2.	周俭, 王征, 孙健, 等. 联合肝脏离断和门静脉结扎的二步肝切除术. 中华消化外科杂志, 2013, 12(7): 485-489.
3.	Wanis KN, Ardiles V, Alvarez FA, et al. Intermediate-term survival and quality of life outcomes in patients with advanced colorectal liver metastases undergoing associating liver partition and portal vein ligation for staged hepatectomy. Surgery, 2018, 163(4): 691-697.
4.	D’Haese JG, Neumann J, Weniger M, et al. Should ALPPS be used for liver resection in intermediate-stage HCC? Ann Surg Oncol, 2016, 23(4): 1335-1343.
5.	Rao RN, Pandey R, Rana MK, et al. Pancreatic and peripancreatic tuberculosis presenting as hypoechoic mass and malignancy diagnosed by ultrasound-guided fine-needle aspiration cytology. J Cytol, 2013, 30(2): 130-135.
6.	Cengiz A, Göksel S, Yürekli Y. Diagnostic value of ¹⁸F-FDG PET/CT in patients with carcinoma of unknown primary. Mol Imaging Radionucl Ther, 2018, 27(3): 126-132.
7.	毛凯, 王捷. 肝癌合并肝外转移的外科治疗现状. 中华外科杂志, 2019, 57(6): 466-470.
8.	孙永琨. 2018《CSCO原发性肝癌诊疗指南》解读—全身治疗部分. 肝癌电子杂志, 2018, 5(3): 11-14.
9.	文张, 徐邦浩, 王继龙, 等. 肝动脉戴戒限流术联合肝脏分隔和门静脉结扎的二步肝切除术治疗巨块型肝癌的临床疗效. 中华消化外科杂志, 2019, 18(5): 489-498.
10.	Alvarez FA, Ardiles V, Sanchez Claria R, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks. J Gastrointest Surg, 2013, 17(4): 814-821.
11.	Olthof PB, Coelen RJS, Wiggers JK, et al. High mortality after ALPPS for perihilar cholangiocarcinoma: case-control analysis including the first series from the international ALPPS registry. HPB (Oxford), 2017, 19(5): 381-387.
12.	Qu C, Qu LL, Zhu CZ, et al. Treatment of primary hepatic neuroendocrine tumors with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): A case report and literature review. Medicine (Baltimore), 2018, 97(37): e12408.
13.	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.
14.	Herman P, Krüger JA, Perini MV, et al. High mortality rates after ALPPS: the devil is the indication. J Gastrointest Cancer, 2015, 46(2): 190-194.
15.	Ulmer TF, de Jong C, Andert A, et al. ALPPS procedure in insufficient hypertrophy after portal vein embolization (PVE). World J Surg, 2017, 41(1): 250-257.
16.	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.
17.	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.
18.	Kokudo N, Shindoh J. How can we safely climb the ALPPS? Updates Surg, 2013, 65(3): 175-177.
19.	Cai YL, Song PP, Tang W, et al. An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence. Medicine (Baltimore), 2016, 95(24): e3941.
20.	Qi F, Zhou A, Yan L, et al. The diagnostic value of PIVKA-Ⅱ, AFP, AFP-L3, CEA, and their combinations in primary and metastatic hepatocellular carcinoma. J Clin Lab Anal, 2020, 34(5): e23158.
21.	Jia Z, Tu J, Cao C, et al. Liver abscess following transarterial chemoembolization for the treatment of hepatocellular carcinoma: A retrospective analysis of 23 cases. J Cancer Res Ther, 2018, 14(Supplement): S628-S633.
22.	Schneider NC, Coelho N, Dutra P, et al. Liver abscess as a first manifestation of colonic tumor. Endosc Ultrasound, 2014, 3(Suppl 1): S11-S12.
23.	Taylor S, Lobritto S, Orellana K, et al. Pyogenic liver abscess masquerading as a hepatic neoplasm. J Pediatr Gastroenterol Nutr, 2015, 61(1): e2-e3.

1. 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.
2. 周俭, 王征, 孙健, 等. 联合肝脏离断和门静脉结扎的二步肝切除术. 中华消化外科杂志, 2013, 12(7): 485-489.
3. Wanis KN, Ardiles V, Alvarez FA, et al. Intermediate-term survival and quality of life outcomes in patients with advanced colorectal liver metastases undergoing associating liver partition and portal vein ligation for staged hepatectomy. Surgery, 2018, 163(4): 691-697.
4. D’Haese JG, Neumann J, Weniger M, et al. Should ALPPS be used for liver resection in intermediate-stage HCC? Ann Surg Oncol, 2016, 23(4): 1335-1343.
5. Rao RN, Pandey R, Rana MK, et al. Pancreatic and peripancreatic tuberculosis presenting as hypoechoic mass and malignancy diagnosed by ultrasound-guided fine-needle aspiration cytology. J Cytol, 2013, 30(2): 130-135.
6. Cengiz A, Göksel S, Yürekli Y. Diagnostic value of ¹⁸F-FDG PET/CT in patients with carcinoma of unknown primary. Mol Imaging Radionucl Ther, 2018, 27(3): 126-132.
7. 毛凯, 王捷. 肝癌合并肝外转移的外科治疗现状. 中华外科杂志, 2019, 57(6): 466-470.
8. 孙永琨. 2018《CSCO原发性肝癌诊疗指南》解读—全身治疗部分. 肝癌电子杂志, 2018, 5(3): 11-14.
9. 文张, 徐邦浩, 王继龙, 等. 肝动脉戴戒限流术联合肝脏分隔和门静脉结扎的二步肝切除术治疗巨块型肝癌的临床疗效. 中华消化外科杂志, 2019, 18(5): 489-498.
10. Alvarez FA, Ardiles V, Sanchez Claria R, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks. J Gastrointest Surg, 2013, 17(4): 814-821.
11. Olthof PB, Coelen RJS, Wiggers JK, et al. High mortality after ALPPS for perihilar cholangiocarcinoma: case-control analysis including the first series from the international ALPPS registry. HPB (Oxford), 2017, 19(5): 381-387.
12. Qu C, Qu LL, Zhu CZ, et al. Treatment of primary hepatic neuroendocrine tumors with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): A case report and literature review. Medicine (Baltimore), 2018, 97(37): e12408.
13. 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.
14. Herman P, Krüger JA, Perini MV, et al. High mortality rates after ALPPS: the devil is the indication. J Gastrointest Cancer, 2015, 46(2): 190-194.
15. Ulmer TF, de Jong C, Andert A, et al. ALPPS procedure in insufficient hypertrophy after portal vein embolization (PVE). World J Surg, 2017, 41(1): 250-257.
16. 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.
17. 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.
18. Kokudo N, Shindoh J. How can we safely climb the ALPPS? Updates Surg, 2013, 65(3): 175-177.
19. Cai YL, Song PP, Tang W, et al. An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence. Medicine (Baltimore), 2016, 95(24): e3941.
20. Qi F, Zhou A, Yan L, et al. The diagnostic value of PIVKA-Ⅱ, AFP, AFP-L3, CEA, and their combinations in primary and metastatic hepatocellular carcinoma. J Clin Lab Anal, 2020, 34(5): e23158.
21. Jia Z, Tu J, Cao C, et al. Liver abscess following transarterial chemoembolization for the treatment of hepatocellular carcinoma: A retrospective analysis of 23 cases. J Cancer Res Ther, 2018, 14(Supplement): S628-S633.
22. Schneider NC, Coelho N, Dutra P, et al. Liver abscess as a first manifestation of colonic tumor. Endosc Ultrasound, 2014, 3(Suppl 1): S11-S12.
23. Taylor S, Lobritto S, Orellana K, et al. Pyogenic liver abscess masquerading as a hepatic neoplasm. J Pediatr Gastroenterol Nutr, 2015, 61(1): e2-e3.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

MDT discussion of a case of intraperitoneal mass after associating liver partition and portal vein ligation for staged hepatectomy

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