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Objective: The aim of this study was to evaluate the short- and long-term outcome of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for hepatitis-related hepatocellular carcinoma (HCC). Summary Background Data: ALPPS has been advocated for future liver remnant (FLR) augmentation in liver metastasis or noncirrhotic liver tumors in recent years. Data on the effect of ALPPS in chronic hepatitis or cirrhosis-related HCC remained scarce. Methods: Data for clinicopathological details, portal hemodynamics, and oncological outcome were reviewed for ALPPS and compared with portal vein embolization (PVE). Tumor immunohistochemistry for PD-1, VEGF, and AFP was evaluated in ALPPS and compared with PVE and upfront hepatectomy (UH). Results: From 2002 to 2018, 148 patients with HCC (hepatitis B: n = 136, 92.0%) underwent FLR modulation (ALPPS, n = 46; PVE: n = 102). One patient with ALPPS and 33 patients with PVE failed to proceed to resection (resection rate: 97.8% vs 67.7%, P < 0.001). Among those who had resections, 65 patients (56.5%) had cirrhosis. ALPPS induced absolute FLR volume increment by 48.8%, or FLR estimated total liver volume ratio by 12.8% over 6 days. No difference in morbidity (20.7% vs 30.4%, P = 0.159) and mortality (6.5% vs 5.8%, P = 1.000) with PVE was observed. Chronic hepatitis and intraoperative indocyanine green clearance rate ≤39.5% favored adequate FLR hypertrophy in ALPPS. Five-year overall survival for ALPPS and PVE was 46.8% and 64.1% (P = 0.234). Tumor immunohistochemical staining showed no difference in expression of PD-1, V-EGF, and AFP between ALPPS, PVE, and UH. Conclusions: ALPPS conferred a higher resection rate in hepatitis-related HCC with comparable short- and long-term oncological outcome with PVE.

Community-based participatory research (CBPR) is a methodology increasingly used within the social sciences. CBPR is an umbrella term that encompasses a variety of research methodologies, including participatory research, participatory action research, feminist participatory research, action research, and collaborative inquiry. At its core, they share five key attributes: (i) community as a unit of identity; (ii) an approach for the vulnerable and marginalized; (iii) collaboration and equal partnership throughout the entire research process; (iv) an emergent, flexible, and iterative process; and (v) the research process is geared toward social action. While there is no shortage of literature that highlights the benefits and potential of CBPR, relatively little discussion exists on the ethical issues associated with the methodology. In particular, current gaps within the literature include ethical guidance in (i) balancing community values, needs, and identity with those of the individual; (ii) negotiating power dynamics and relationships; (iii) working with stigmatized populations; (iv) negotiating conflicting ethical requirements and expectations from Institutional Review Boards (IRBs); and (v) facilitating social action emerging from the findings. For CBPR’s commendable goals and potential to be realized, it is necessary to have a more fulsome discussion of the ethical issues encountered while implementing a CBPR study. Further, a lack of awareness and critical reflection on such ethical considerations may perpetuate the very same problems this methodology seeks to address, namely, inequality, oppression, and marginalization. The purpose of this article is to provide a narrative review of the literature that identifies ethical issues that may arise from conducting CBPR studies, and the recommendations by researchers to mitigate such challenges.

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