Assocating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) for Huge Hepatocellular Carcinoma Combined with Liver Cirrhosis and Portal Hypertension = Assocating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) for Huge Hepatocellular Carcinoma Combined with Liver Cirrhosis and Portal Hypertension
저자
( Pyoung-jae Park ) ; ( Tae Wan Lim ) ; ( Sae Byeol Choi ) ; ( Wan Bae Kim ) ; ( Sang Yong Choi )
발행기관
학술지명
권호사항
발행연도
2016
작성언어
-KDC
500
자료형태
학술저널
수록면
166-166(1쪽)
제공처
Purpose: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been developed for patients with predicted insufficient future liver remnant volumes to induce more rapid hepatic hypertrophy and increase resectability. It has been usually performed for metastatic liver cancer from colorectal cancer, but few reports about ALPPS for hepatocellular carcinoma, especially in the liver cirrhosis combined portal hypertension were published. Especially, any treatment options of huge HCC under liver cirrhosis with portal hypertension were not proper. We reported a successful case of ALPPS for huge HCC combined with liver cirrhosis and portal hypertension. Methods: A 58-year-old female patient was admitted for abdominal pain for 3 months. She had a history of chronic hepatitis B, but it was not treated. On abdominal CT, about 20cm sized huge heterogeneously enhancing mass was identified and replaced to the right hepatic lobe. Right glisson and right hepatic vein were compressed and it invaded to middle hepatic vein and segment 4. Nodularity of liver surface, moderate splenomegaly and enlarged varices were identified. AFP level was severely increased to 158389 ng/mL and PIVKA-II level was over 100,000 mAU/mL. ICG 15(%) was checked to 48.2%. It was suggested to severe liver cirrhosis and inoperable state. The future remnant liver volume (LLS+S1) on CT volumetry was 306 mL (291+15). Severe post-hepatectomy liver failure was strongly expected and so ALPPS was planned. Results: During 1st stage operation, the partition between left lateral section and S4, right anterior portal vein ligation was performed. The partition plane was covered with Proceed mesh. The reason of right anterior portal vein ligation was that cental hepatectomy was preferred to right tri-sectionectomy if right tri-sectionectomy would make post-hepatectomy liver failure even though ALPPS was performed. Total bilirubin level was increased to 2.22 mg/dL but CT volume of left lateral section was increased to 387 mL at postoperative 12 days. 2nd stage operation was performed at 14 postoperative days. During 2nd stage operation, anatomical central hepatectomy was performed without sacrifice of the right posterior section with right posterior glisson and right hepatic vein. Total bilirubin level was increased to 5.13 mg/dL on new postoperative 1 day, but it was recovered to normal range on postoperative 12 days. CT remnant liver volume (SLLS+S1+RPS) was 589mL (395+16+178) at postoperative 8 days although biloma was identified at resection area. She recovered at postoperative 1 month. Conclusion: Although the validity and oncologic safety of ALPPS were not yet fully investigated, ALPPS for HCC under severe liver cirrhosis with portal hypertension was possible and more studies are needed to further evaluate its effectiveness and oncological outcomes. Figure 1. (A) preoperative CT shows that huge HCC (>20cm) compresses of right glisson; (B) CT between 1st stage and 2nd stage operation shows increased volume of left lateral section and the partition between left lateral section and S4 (blue arrow); (C) CT after 2nd stage operation shows succesful central hepatectomy. Figure 2. (A) Huge HCC underlying severe liver cirrhosis was identified during 1st operation, (B) 1st stage operation: the partition between left lateral section and S4, right anterior portal vein ligation The partition plane was covered with Proceed mesh, (C) 2nd stage operation: the anatomical central hepatectomy.
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