ObjectiveTo 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. MethodThe 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. ResultsA 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. ConclusionsBased 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.
ObjectiveTo discussion the indications and contradictions of associating liver partition and potal vein ligation for staged hepatectomy (ALPPS) for primary hepatocellular carcinoma patients. MethodsThe date of 15 patients underwent the ALPPS in West China Hospital between Augst, 2014 and March, 2015 were retrospectively analyzed. The efficacy of the treatment was evaluated by blood test, the volume of residual liver growth, and postoperative follow-up. ResultsFourteen cases underwent the complete ALPPS, 1 case lost because it couldn't match the standard for the second step. The median increase in the future liver remnant(FLR) volume was 205.5 cm3[(-7.92)-270.6 cm3] and the median rate of FLR increase was 56.5%[(-1.89%)-134.74%]. One case died in the perioperative period for the liver failure, 2 cases was found recurrence or metastasis and died in 3 and 4 months after operation, respectively. One case's AFP was found rising but no iconography evidence for recurrence. One case with tumor survival about 4 moths. The remaining 10 patients were alive without recurrence and metastasis. ConclusionsALPPS is a feasible strategy in patients with cirrhosis and can improve the resectability of hepatocellular carcinoma to provide a chance of a cure to those who would not otherwise be able to receive surgery. And we put out an indications and contradictions for ALPPS tentatively.