A Clinical Investigation On Feasibility And Safety Of Two-stage Hepatectomy Based On Portal Vein Embolization Or Ligation In The Treatment Of Hepatocellular Carcinoma

ObjectiveThe two-step hepatectomy with portal vein embolization or ligation was designed to prevent hepatic failure due to insufficient future liver remnant after hepatectomy.Based on retrospective analysis of clinical data of hepatocellular carcinoma patients who adopting the two-step hepatectomy,to study the feasibility and safety of portal vein embolization or ligation in such cases,and to discuss the influence on the growth rate of future liver remnant in compensatory cirrhosis.MethodsA retrospective study was carried out in 16 patients with hepatocellutar carcinoma who underwent two-stage hepatectomy from July 1,2013 to December 31,2018 in Zhongda Hospital.Patients were 7 with cirrhosis and 9 with non-cirrhosis.According to the data before and after the first step operation,a self-comparison study was used.Date including future liver remnant,albumin,proprotein,ALT,AST and TBil and postoperative complications were collected separatlly.The growth rate of future liver remnant in patients with and without cirrhosis was compared at the same time.ResultsResults showed that the future liver remnant was significantly increased after PVE or PVL procedure(519.67±125.62cm~3 v.s.381.55±91.59cm~3,p<0.05).After two-step hepatectomy,albumin and preprotein decreased significantly,ALT and AST and TBil appeared to rise,but all the liver function data above could recover gradually.The result displayed that the future liver remnant increased significantly in both groups after the first step.However,the future liver remnant in the compensatory cirrhosis group was significantly lower than that in the non-cirrhosis group(118.22±68.63cm~3 v.s.168.68±112.02cm~3,p<0.05).At the same time,the growth rate of liver volume in the compensatory cirrhosis group was slower than that in the non-cirrhosis group(4.54±2.64 cm~3/d v.s.7.67±5.09 cm~3/d,p<0.05).Analysis of variance showed that the liver function between compensatory cirrhosis group and non-cirrhosis group didn’t have significant difference.ConclusionsThe two-step hepatectomy with portal vein embolization or ligation is safe and feasible for large cases of hepatocellular carcinoma with insufficient future liver remnant.The growth rate of future liver remnant on non-cirrhosis patients is faster than compensatory cirrhosis patients.