Feasibility And Safety Evaluation Of Two-step Hepatectomy Combined With Liver Disconnection And Portal Vein Ligation

Objective:Associating liver partition and portal vein ligation for staged he patectomy(ALPPS)is aimed to prevent acute liver failure from the small size of the future liver remnant(FLR)after major hepatectomy.To identify the feasibility and safety of this surgical approach in the case of huge liver cancer with cirrhosis,we retrospectively analyzing the clinical data.Methods:Retrospectively analysis 9 cases of huge liver cancer with cirrhosis which underwent ALPPS in the liver surgery department of Peking Union Medical College Hospital,date from September 2014 to October 2016.The major endpoint were completion of second step,future liver remnant(FLR)growth rate,mortality.Systemic review and Meta analysis were performed to compare ALPPS with the traditional staged hepatectomy.Results:All nine cases were completed two steps and no serious complications occurred;no postoperative death cases.ALPPS group have a higher FLR increase rate than PVE and PVL,the difference was statistically significant(42.2%;95%CI 26.52-57.87,P<0.001;47.65%;95%CI 29.43-65.88%,P<0.001);There was no significant difference in morbility and motality between the ALPPS and PVE.PVL group(27.7%;OR 0.723,95%CI 0.258-2.207,P = 0.537;44.7%;OR 0.553,95%CI 0.158-1.938,P = 0.371),(35.6%;OR 0.644,95%CI 0.166-2.499,P = 0.524;42.9%;OR 0.571,95%CI 0.07-4.683,P ?0.602).Conclusions:ALPPS is safe and feasible for patients with massive hepatocellular carcinoma with insufficient FLR,which provides surgical treatment for these patients.compared with the traditional staged hepatectomy,ALPPS can get faster FLR growth,complications and mortality was no significant difference.