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Khajeh E, Ramouz A, Dooghaie Moghadam A, Aminizadeh E, Ghamarnejad O, Ali-Hassan-Al-Saegh S, Hammad A, Shafiei S, Abbasi Dezfouli S, Nickkholgh A, Golriz M, Goncalves G, Rio-Tinto R, Carvalho C, Hoffmann K, Probst P, Mehrabi A. Efficacy of Technical Modifications to the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure: A Systematic Review and Meta-Analysis. ANNALS OF SURGERY OPEN 2022; 3:e221. [PMID: 37600287 PMCID: PMC10406102 DOI: 10.1097/as9.0000000000000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
To compare the outcomes of modified-Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) techniques with those of conventional-ALPPS. Background ALPPS is an established technique for treating advanced liver tumors. Methods PubMed, Web of Science, and Cochrane databases were searched. The outcomes were assessed by single-arm and 2-arm analyses. Results Seventeen studies containing 335 modified-ALPPS patients were included in single-arm meta-analysis. The estimated blood loss was 267 ± 29 mL (95% confidence interval [CI], 210-324 mL) during the first and 662 ± 51 mL (95% CI, 562-762 mL) during the second stage. The operation time was 166 ± 18 minutes (95% CI, 131-202 minutes) during the first and 225 ± 19 minutes (95% CI, 188-263 minutes) during the second stage. The major morbidity rate was 14% (95% CI, 9%-22%) after the first stage. The future liver remnant hypertrophy rate was 65.2% ± 5% (95% CI, 55%-75%) and the interstage interval was 16 ± 1 days (95% CI, 14-17 days). The dropout rate was 9% (95% CI, 5%-15%). The overall complication rate was 46% (95% CI, 37%-56%) and the major complication rate was 20% (95% CI, 14%-26%). The postoperative mortality rate was 7% (95% CI, 4%-11%). Seven studies containing 215 patients were included in comparative analysis. The hypertrophy rate was not different between 2 methods (mean difference [MD], -5.01; 95% CI, -19.16 to 9.14; P = 0.49). The interstage interval was shorter for partial-ALPPS (MD, 9.43; 95% CI, 3.29-15.58; P = 0.003). The overall complication rate (odds ratio [OR], 10.10; 95% CI, 2.11-48.35; P = 0.004) and mortality rate (OR, 3.74; 95% CI, 1.36-10.26; P = 0.01) were higher in the conventional-ALPPS. Conclusions The hypertrophy rate in partial-ALPPS was similar to conventional-ALPPS. This shows that minimizing the first stage of the operation does not affect hypertrophy. Moreover, the postoperative overall morbidity and mortality rates were lower following partial-ALPPS.
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Affiliation(s)
- Elias Khajeh
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Ali Ramouz
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Arash Dooghaie Moghadam
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Ehsan Aminizadeh
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Omid Ghamarnejad
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Sadeq Ali-Hassan-Al-Saegh
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Ahmed Hammad
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Saeed Shafiei
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Sepehr Abbasi Dezfouli
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Arash Nickkholgh
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Mohammad Golriz
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Gil Goncalves
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Ricardo Rio-Tinto
- Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Carlos Carvalho
- Department of Clinical Oncology, Digestive Unit, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Katrin Hoffmann
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Pascal Probst
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
| | - Arianeb Mehrabi
- From the Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
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Jin Z, Wu G, Xu B, Wang J, Zhu H, Guo Y, Peng M, Peng T, Wen Z. Case Report: Combining liver partition and portal vein ligation after thrombectomy for tumor isolation (CLAPT) to treat advanced hepatocellular carcinoma with portal vein tumor thrombosis. Front Surg 2022; 9:928452. [PMID: 36176342 PMCID: PMC9513360 DOI: 10.3389/fsurg.2022.928452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 01/27/2023] Open
Abstract
Background Primary liver cancer is the third leading cause of cancer-related deaths worldwide in 2020, and hepatocellular carcinoma (HCC) is the major pathological type. Patients with HCC complicated with portal vein tumor thrombosis (PVTT) have a poor prognosis, and controversies regarding treatment options exist among international scholars. Patients with VP4 or Cheng’s type III classification are generally considered ineligible for surgical treatment. Methods We retrospectively analyzed three cases of HCC with PVTT who underwent a novel modified surgical procedure. The procedure included portal vein thrombectomy and portal vein ligation with liver parenchymal separation for the resection of the tumor thrombus involving the main portal vein trunk and for the isolation of the giant tumor. The three cases were then treated with targeted drugs postoperatively. Results One case developed acute renal failure in the perioperative period, and the renal function gradually recovered after the treatment. The two remaining cases recovered uneventfully postoperatively. The prognosis of the three patients was encouraging. Only one patient died of lung metastasis after 13 months, and the remaining patients were still alive after 41 and 21 months, respectively. Conclusions We provide a new possible surgical option for patients with advanced HCC with PVTT. The surgical procedure was inspired by associating liver partition with portal vein ligation for staged hepatectomy and portal vein thrombectomy. The survival time was significantly prolonged after the patients underwent thrombectomy, tumor isolation, and postoperative nonsurgical treatment. Hence, the combination of liver partition and portal vein ligation after thrombectomy for tumor isolation has the potential for the treatment of advanced HCC with PVTT.
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Lai Y, Lee JC, Hung HC, Cheng CH, Wu TH, Lee CF, Wu TJ, Chou HS, Chan KM, Lee WC. Models to predict disease-free survival for hepatocellular carcinoma patients with surgical resections. J Surg Oncol 2020; 122:1444-1452. [PMID: 32875573 DOI: 10.1002/jso.26169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/27/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Precise prognostic prediction for an individual hepatocellular carcinoma (HCC) patient before and after liver resection is important. We aimed to establish simple prognostic models to predict disease-free survival (DFS) for these patients. METHODS Six hundred and ninety-eight HCC patients with liver resections were reviewed. Preoperative (model 1) and postoperative (model 2) nomogram-based scoring systems were constructed by multivariate analyses, and DFS was estimated. RESULTS Among 698 patients, 490 (70.2%) patients had tumor recurrence at a median follow-up of 84.4 months. Risk factors of tumor recurrence in model 1 included viral hepatitis, platelet count, albumin, indocyanine green retention rate, multiplicity of tumor, and radiologic total tumor volume (TTV). Prognostic variables identified in model 2 were viral hepatitis, platelet count, multiplicity of tumor, cirrhosis, microvascular invasion, and pathologic TTV. By nomogram in model 1, the patients were classified into three groups with 5-year DFS of 61.0%, 35.7%, and 21.1%, respectively (P < .0001). In model 2, the patients were divided into five groups with 5-year DFS of 58.0%, 43.7%, 24.0%, 15.4%, and 0.0%, respectively (P < .0001). CONCLUSION Based on nomogram models, DFS for the patients who had liver resection for HCC can be predicted before liver resection and re-assessed after liver resection.
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Affiliation(s)
- Yin Lai
- Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Jin-Chiao Lee
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Hao-Chien Hung
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Hsien Cheng
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsung-Han Wu
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Chen-Fang Lee
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Ting-Jung Wu
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Hong-Shiue Chou
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Kun-Ming Chan
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
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Gao S, Xu X, Wang Y, Zhang W, Wang X. Diagnostic utility of plasma lncRNA small nucleolar RNA host gene 1 in patients with hepatocellular carcinoma. Mol Med Rep 2018; 18:3305-3313. [PMID: 30066898 PMCID: PMC6102699 DOI: 10.3892/mmr.2018.9336] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/12/2018] [Indexed: 12/13/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) offer great potential as cancer biomarkers. Owing to the limited sensitivity and specificity of α-fetoprotein (AFP) for the diagnosis of hepatocellular carcinoma (HCC), the present study used an lncRNA microarray to screen aberrantly expressed lncRNAs in HCC tissues. Subsequently, the expression profile of the target lncRNAs was investigated in plasma from patients with HCC or hepatitis B virus-positive chronic hepatitis and cirrhosis (HCH), as well as from healthy volunteers. A total of six aberrantly expressed lncRNAs were identified in HCC tissues and corresponding normal tissues, from which only small nucleolar RNA host gene 1 (SNHG1) expression in HCC tissues demonstrated a good correlation with those in plasma from HCC patients. Subsequent analysis revealed that high plasma SNHG1 expression levels were correlated with tumor size, TNM stage and AFP levels. Receiver operating characteristic analysis demonstrated that SNHG1 yields an excellent diagnostic ability to differentiate between patients with HCC and unaffected control patients, which was superior to that of AFP. The combination of SNHG1 with AFP may be able to distinguish HCC from HCH or healthy volunteers with the area under the curve values of 0.86 and 0.97, respectively. In summary, it was demonstrated that plasma SNHG1 has great potential as a sensitive and reliable biomarker for the diagnosis of HCC.
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Affiliation(s)
- Shoubao Gao
- Department of Oncology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161021, P.R. China
| | - Xiaohong Xu
- Department of Clinical Laboratory, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161021, P.R. China
| | - Yue Wang
- Medical School of Nanchang University, Nanchang, Jiangxi 330031, P.R. China
| | - Wei Zhang
- Department of Oncology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161021, P.R. China
| | - Xingye Wang
- Department of Clinical Laboratory, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161021, P.R. China
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Ma X, Yuan T, Yang C, Wang Z, Zang Y, Wu L, Zhuang L. X-inactive-specific transcript of peripheral blood cells is regulated by exosomal Jpx and acts as a biomarker for female patients with hepatocellular carcinoma. Ther Adv Med Oncol 2017; 9:665-677. [PMID: 29344104 PMCID: PMC5764152 DOI: 10.1177/1758834017731052] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/03/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Long noncoding ribonucleic acid (lncRNA) X-inactive-specific transcript (Xist) was reported to affect cell proliferation and metastasis in hepatocellular carcinoma (HCC). However, there are rare reports focusing on the diagnostic evaluation and regulatory mechanism of Xist expression from peripheral blood cells of patients with HCC. Methods: In this study, a cohort of 206 female participants including healthy volunteers (HVs) and patients with chronic hepatitis B (CHB), cirrhosis and HCC was recruited. Coculture system was used to evaluate the effects of exosomal JPX transcript, XIST activator (Jpx) on Xist expression of blood cells. Results: First, Xist expressions of both peripheral blood mononuclear cells and granulocytes were upregulated in female patients with HCC, and showed significantly increased discriminatory power when differentiating female patients with early-stage HCC from controls or differentiating female patients with HCC from patients with CHB and cirrhosis, compared with alpha fetoprotein (AFP). Then, another lncRNA Jpx that was an activator of Xist was upregulated in exosomes, mononuclear cells and granulocytes of female patients with HCC. Furthermore, our results showed that Jpx could be delivered from HCC cells to blood cells via exosomes and activate Xist expression of blood cells by repressing the transregulatory effects of CCCTC-binding factor (CTCF). Conclusions: This study revealed an exosome-mediated regulation of Xist expression in blood cells and suggested that Xist expressions of mononuclear cells and granulocytes would be promising biomarkers for diagnosis of female patients with HCC.
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Affiliation(s)
- Xiang Ma
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, China
| | - Tingdong Yuan
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, China
| | - Chao Yang
- Department of Infectious Diseases, The Affiliated Hospital of Qingdao University, China
| | - Zusen Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, China
| | - Yunjin Zang
- Institute of Transplantation Science, The Affiliated Hospital of Qingdao University, China
| | - Liqun Wu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, China
| | - Likun Zhuang
- Institute of Transplantation Science, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, China
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Wong RJ, Ahmed A, Gish RG. Elevated alpha-fetoprotein: differential diagnosis - hepatocellular carcinoma and other disorders. Clin Liver Dis 2015; 19:309-23. [PMID: 25921665 DOI: 10.1016/j.cld.2015.01.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The incidence of cirrhosis-related hepatocellular carcinoma (HCC) is rising. Curative surgical options are available; outcomes are acceptable with early diagnosis. Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) and des-gamma-carboxy prothrombin (DCP) are HCC risk markers. A high or increasing serum biomarker level can be predictive of the eventual development of HCC, large tumor size, advanced stage, extrahepatic metastases, portal vein thrombosis, and postoperative HCC recurrence. Based on FDA guidelines for HCC risk assessment, clinicians can consider using either the combination of AFP-L3 with DCP, or the combination of AFP-L3 with AFP and DCP.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Highland Care Pavilion, 5th floor, 1411 East 31st Street, Oakland, CA 94602, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite# 210, Palo Alto, CA 94304, USA; Liver Transplant Program, Stanford University Medical Center, 750 Welch Road, Suite# 210, Palo Alto, CA 94304, USA
| | - Robert G Gish
- Liver Transplant Program, Stanford University Medical Center, 750 Welch Road, Suite# 210, Palo Alto, CA 94304, USA; Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA 18902, USA.
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Zhang Y, Yang H, Chen Y, Zhu S, Lu T, Jun X. Totally Laparoscopic Associating Liver Tourniquet and Portal Ligation for Staged Hepatectomy via Anterior Approach for Cirrhotic Hepatocellular Carcinoma. J Am Coll Surg 2015. [PMID: 26206661 DOI: 10.1016/j.jamcollsurg.2015.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Yu Zhang
- Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, Chengdu, China
| | - Hongji Yang
- Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, Chengdu, China.
| | - Yunfei Chen
- Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, Chengdu, China
| | - Shikai Zhu
- Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, Chengdu, China
| | - Tao Lu
- Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, Chengdu, China
| | - Xu Jun
- Third Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences (Sichuan Provincial People's Hospital), Chinese Academy of Sciences, Chengdu, China
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Squires MH, Kooby DA. Hepatocellular Carcinoma. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Abstract
Hepatocellular Carcinoma (HCC) continues to present major challenges in management, which is further complicated by the presence of associated chronic liver disease. Key issues in surgical resection of HCC include the site, size, and number of lesions, the severity of the chronic liver disease, and the size of the functional liver remnant. De novo HCC in the absence of chronic liver disease can be treated by major liver resection with little risk of postoperative liver failure. Liver resection can also be used a bridge to liver transplantation as it affords the possibility of determining the pathologic grade of the tumortumor and its invasiveness, and thereby the prognosis. This review summarizes the current treatment approaches to surgical resection for HCC.
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Key Words
- AFP, alpha-fetoprotein
- AFP/TTV, AFP to tumor volume
- ASA, American Society of Anesthesiologists
- BCLC, barcelona clinic liver cancer
- CT, computerized tomography
- CTP, child-turcotte-pugh
- CUSA, cavitary ultrasound suction aspirator
- FDG-PET, fludeoxyglucose positron emission tomography
- FLR, functioning liver remnant
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HPB, hepato-pancreato-biliary
- HVPG, hepatic venous pressure gradient
- MELD, model for end-stage liver disease
- PEI, percutaneous ethanol injection
- POLT, primary orthotopic liver transplantation
- PVE, portal vein embolization
- RFA, radiofrequency ablation
- TACE, transarterial chemoembolization
- UCSF, University of California, San Francisco
- hepatocellular carcinoma
- liver cancer
- liver tumor
- resection
- surgery
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Affiliation(s)
- Hariharan Ramesh
- Address for correspondence: Hariharan Ramesh, Director of Surgical Gastroenterology & Liver Transplantation, Lakeshore Hospital & Research Center, Cochin, Kerala, India.
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Zhang GQ, Zhang ZW, Lau WY, Chen XP. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): a new strategy to increase resectability in liver surgery. Int J Surg 2014; 12:437-41. [PMID: 24704086 DOI: 10.1016/j.ijsu.2014.03.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 03/05/2014] [Accepted: 03/16/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Partial hepatectomy with clear surgical margins is the main curative treatment for hepatic malignancies. The safety of liver resection, to a great extent, depends on the volume of future liver remnant. This manuscript reviews some important strategies that have been developed to increase resectability for patients with borderline volume of future liver remnant, particularly associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). METHODS To identify potentially relevant articles, we searched Medline and PubMed from January 2010 to December 2013 using the keywords "Associating liver partition and portal vein ligation for staged hepatectomy", "ALPPS", "portal vein embolization", "future liver remnant", "liver hypertrophy", and "liver failure". A number of references from the key articles were also cited. There were no exclusion criteria for published information to the topics. RESULTS Portal vein ligation (PVL) or embolization (PVE) are traditional approaches to induce liver hypertrophy of the future liver remnant (FLR) prior to hepatectomy in primarily non-resectable liver tumors. However, about 14 percent of patients fail to this approach. Adequate hypertrophy of the FLR using PVL or PVE generally takes more than four weeks. ALPPS can induce rapid growth of the FLR, which is more effective than by portal vein embolization or occlusion alone. Reportedly, the hypertrophy extent of FLR was 40%-80% within 6-9 days in contrast to approximately 8%-27% within 2-60 days by PVL/PVE. However, ALPPS was reported to have high operative morbidity (16%-64% of patients), mortality (12%-23% of patients) and bile leakage rates. Bile leakage and sepsis remain a major cause of morbidity, and the main cause of mortality includes hepatic insufficiency. CONCLUSION ALPPS has emerged as a new strategy to increase resectability of hepatic malignancies. Due to high morbidity and mortality rates of ALPPS procedure, the surgical candidates should be selected carefully. Moreover, there are very limited available evidence for its technical feasibility, safety and oncological outcome which are needed for further evaluation in larger scale of studies.
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Affiliation(s)
- Guan-Qi Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhi-Wei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wan-Yee Lau
- Faculty of Medicine, the Chinese University of Hong Kong, HongKong, SAR, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Liu L, Xiao Z, Xiao Y, Wang Z, Li F, Li M, Peng X. Potential enhancement of intravenous nano-hydroxyapatite in high-intensity focused ultrasound ablation for treating hepatocellular carcinoma in a rabbit model. Oncol Lett 2014; 7:1485-1492. [PMID: 24765161 PMCID: PMC3997670 DOI: 10.3892/ol.2014.1900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 01/15/2014] [Indexed: 11/17/2022] Open
Abstract
The aim of the present study was to evaluate the safety and efficiency of an intravenously delivered nano-hydroxyapatite (Nano-HA) solution into a rabbit model (Oryctolagus cuniculus) to determine the potential enhancement of high-intensity focused ultrasound (HIFU) for the ablation of hepatocellular carcinoma (HCC) in liver tissue. The present study clearly indicated that the intravenous delivery of large quantities of Nano-HA into the body of the rabbit model over relatively short periods of time may be absorbed by the hepatic reticuloendothelial system. Subsequent HIFU treatment for HCC, as well as intravenous Nano-HA, produced a rapid increase in temperature and an enlargement of the coagulated necrotic area during ablation in the in vivo and ex vivo environments. In addition, it was found that the therapeutic doses of Nano-HA produced mild and transient abnormalities in the normal renal function and hepatic enzymes during the first 24 h following administration. The results of the current study indicated that the combination of Nano-HA and HIFU may provide a safe and effective alternative to conventional surgical procedures.
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Affiliation(s)
- Liping Liu
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Ziwen Xiao
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Yanbing Xiao
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Zhibiao Wang
- Department of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Faqi Li
- Department of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Maoping Li
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xiaoqiong Peng
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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Fang Y, Chen W, Liang X, Li D, Lou H, Chen R, Wang K, Pan H. Comparison of long-term effectiveness and complications of radiofrequency ablation with hepatectomy for small hepatocellular carcinoma. J Gastroenterol Hepatol 2014; 29:193-200. [PMID: 24224779 DOI: 10.1111/jgh.12441] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM To determine and compare the adverse events and long-term effectiveness for patients with small hepatocellular carcinoma (HCC) (≤ 3 cm) treated by percutaneous radiofrequency ablation (RFA) or hepatectomy. METHODS Small HCC from 120 patients were randomized into either percutaneous RFA therapy or hepatectomy group, and the effectiveness and complications of two treatment modalities were analyzed. The complications of post-RFA or hepatectomy, the complete treatment rate, treatment-related mortality, and disease-free and overall survival rate were followed up and conducted. RESULTS In patients with small HCC, complete remission rates were achieved in 95% and 96.7% in the percutaneus RFA and hepatectomy groups, respectively (P > 0.05). Hepatic function at day-7 status post-treatment, including albumin and bilirubin levels, were significantly worse in the hepatectomy group (P < 0.01). Compared with the RFA group, the incidence of postoperative complications (27.5% vs 5.0%) and hospital stay (11.8 ± 3.1 vs 4.3 ± 1.5) were significantly higher in the hepatectomy group (P < 0.01). After a mean follow-up of 40 months, 22 patients (36.6%) in the RFA group and 21 patients (35.0%) in the hepatectomy group developed a recurrence (P > 0.05). There was no significant difference of the disease-free and overall survival rates at 1, 2, and 3 years between the RFA group and the surgical hepatectomy group (P = 0.443 and P = 0.207, respectively). CONCLUSIONS In patients with small HCC, percutaneous RFA showed similar local control and long-term survival compared with hepatectomy. Importantly, percutaneous RFA are accompanied with a lower complication rate and shorter hospital stay day.
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Affiliation(s)
- Yong Fang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
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Cavaness KM, Doyle MBM, Lin Y, Maynard E, Chapman WC. Using ALPPS to induce rapid liver hypertrophy in a patient with hepatic fibrosis and portal vein thrombosis. J Gastrointest Surg 2013; 17:207-12. [PMID: 22996934 DOI: 10.1007/s11605-012-2029-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 08/27/2012] [Indexed: 01/31/2023]
Affiliation(s)
- Keith M Cavaness
- Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO, USA
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14
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Desiderio J, Trastulli S, Pasquale R, Cavaliere D, Cirocchi R, Boselli C, Noya G, Parisi A. Could radiofrequency ablation replace liver resection for small hepatocellular carcinoma in patients with compensated cirrhosis? A 5-year follow-up. Langenbecks Arch Surg 2012; 398:55-62. [PMID: 23224564 DOI: 10.1007/s00423-012-1029-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 10/29/2012] [Indexed: 01/05/2023]
Abstract
PURPOSE Treating hepatocellular carcinoma involves many different specialists and requires multidisciplinary management. In light of the current discussion on the role of ablative therapy, the aim of this study is to compare patients who undergo hepatic resection to those treated with radiofrequency ablation. METHODS The procedures have been conducted in two institutes following the same methodologies. Ninety-six patients with Child-Pugh class A cirrhosis, single or multinodular hepatocellular carcinoma (HCC) and a diameter less than or equal to 3 cm, have been included in this retrospective study: 52 patients have been treated by surgical resection and 44 by radiofrequency ablation. Patient characteristics, survival and disease-free survival have all been analysed. RESULTS Disease-free survival was longer in the resection group in comparison to the radiofrequency group with a median disease-free time of 48 versus 34 months, respectively (P = 0.04, hazard ratio = 1.5, 95 % confidence interval = 0.9-2.5). In the resection group, median survival was 54 months with a survival rate at 1, 3 and 5 years of 100, 98 and 46.2 %. In the radiofrequency group, median survival was 40 months with 1-, 3- and 5-year survival rate of 95.5, 68.2 and 36.4 %. CONCLUSION The current study shows that for small HCC in the presence of compensated cirrhosis, surgical resection gives better results than radiofrequency, both in terms of overall survival, as well as disease-free survival. Further evidence is required to clarify the role of ablative therapy as a curative treatment and whether it can replace surgery.
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Affiliation(s)
- Jacopo Desiderio
- Department of Digestive Surgery and Liver Unit, University of Perugia, St. Maria Hospital, Via Tristano di Joannuccio, Terni 05100, Italy.
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15
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Particle therapy for cancers: a new weapon in radiation therapy. Front Med 2012; 6:165-72. [DOI: 10.1007/s11684-012-0196-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 03/12/2012] [Indexed: 12/25/2022]
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