ObjectiveTo discuss the clinical application of two-step hepatectomy for hepatic alveolar echinococcosis which invaded the second and the third porta hepatis.MethodsThe clinical data of 60 patients with hepatic alveolar echinococcosis invaded the second and the third porta hepatis who treated with two-step hepatectomy in West China Hospital of Sichuan University and The People’s Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province from Jan. 2013 to Jun. 2017 were analyzed retrospectively.ResultsSixty patients had underwent radical hepatectomy successfully and no death happened during perioperative period. The average operative time was 309.17 min (150–475 min) and intraoperative blood loss was 586.67 mL (100–3 000 mL). Forty-eight patients blocked the blood flowing into the liver, the average blocking time was 25.85 min (15–50 min); 24 patients suffered red blood cell suspension, the average amount was 3.79 U (2–8 U), and 9 patients were infused with fresh frozen plasma, the average amount was 527.78 mL (350–850 mL). The average of hospital stays was 17.5 days (7–39 days) and average of hospitalization cost was 49 323.43 yuan (28 045.32–61 243.15 yuan). The liver function indicators returned to normal within 7 days after operation. After operation, 3 patients suffered from biliary fistula, 3 patients suffered from pleural effusion, 3 patients suffered from peritoneal effusion, 10 patients suffered from effusion. According to the rank of complication: 10 patients were defined as grade Ⅰ, 3 patients were defined as grade Ⅱ, 6 patients were defined as grade Ⅲa. The average follow-up time of 60 patients was 14.47 months (1–31 months). No recurrence and death occurred during follow-up period.ConclusionThe two-step hepatectomy in treatment of hepatic alveolar echinococcosis invaded the second and the third porta hepatis can avoid the large flucyuations of intraoperative blood pressure and other vital signs, can increase the safety of surgery and reduce the difficulty and risk of surgery.
ObjectiveTo investigate the value of laparoscopic liver venous deprivation (LLVD) in promoting the growth of contralateral future liver remnant (FLR) during two-step hepatectomy. MethodThe clinicopathologic data of a 45-year-old female patient with pancreatic neuroendocrine tumor with multiple liver metastases (grade G2) treated by two-step hepatectomy based on LLVD in January 2022 in the Sichuan Provincial People’s Hospital were analyzed retrospectively. ResultsThe liver function returned to normal within 10 d after LLVD, and the relative increase ratio of FLR reached to 98.35% on postoperative day 10. The laparoscopic right hemi-hepatectomy and distal pancreatectomy plus splenectomy was performed without any postoperative complications, and the patient was discharged from hospital on postoperative day 8. No tumor recurrence or metastasis occurred during the follow-up period. ConclusionsFrom the analysis results of this case, the LLVD could promote the growth of FLR safely and effectively. LLVD provides an alternative surgical method of two-step hepatectomy for treatment of benign and malignant liver tumors.
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.