Associating liver partition and portal vein ligation for staged hepatectomy versus sequential transarterial chemoembolization and portal vein embolization in staged hepatectomy for HBV-related hepatocellular carcinoma: a randomized comparative study

Abstract

Background: Both portal vein embolization (PVE) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) have merits and demerits when used in patients with unresectable liver cancers due to insufficient volumes in future liver remnant (FLR).Methods: This study was a single-center, prospective randomized comparative study. Patients with the diagnosis of hepatitis B related hepatocellular carcinoma (HCC) were randomly assigned in a 1:1 ratio to the 2 groups. The primary endpoints were tumor resection and three-year overall survival (OS) rates.Results: Between November 2014 to June 2016, 76 patients with unresectable HBV-related HCC due to inadequate volume of FLR were randomly assigned to ALPPS groups (n=38) and TACE + PVE groups (n=38).Thirty-seven patients (97.4%) in the ALPPS group compared with 25 patients (65.8%) in the TACE + PVE group were able to undergo staged hepatectomy (risk ratio 1.48, 95% CI: 1.17-1.87, P<0.001). The threeyear OS rate of the ALPPS group (65.8%) (95% CI: 50.7-80.9) was significantly better than the TACE + PVE group (42.1%) (95% CI: 26.4-57.8) (HR 0.50, 95% CI: 0.26-0.98, two-sided P=0.036). However, no significant difference in the OS rates between patients who underwent tumor resection in the 2 groups of patients was found (HR 0.80, 95% CI: 0.35-1.83, two-sided P=0.595). Major postoperative complications rates after the stage-2 hepatectomy were 54.1% in the ALPPS group and 20.0% in the TACE + PVE group (risk ratio 2.70, 95% CI: 1.17-6.25, P=0.007).Conclusions: ALPPS resulted in significantly better intermediate-term OS outcomes, at the expenses of a significantly higher perioperative morbidity rate compared with TACE + PVE in patients who had initially unresectable HBV-related HCC.

Mini-ALPPS-based multidisciplinary treatment leading to long-term survival in a patient with a large HCC: A case report

“…Compared with one-stage hepatectomy and PVE, ALPPS could achieve a similar survival benefit. Furthermore, ALPPS could confer better survival benefits than TACE ( 3 , 4 , 19 , 20 ). Our case survived 1,922 days following Mini-ALPPS.…”

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Chinese perspective

“…Systemic therapies like tyrosine kinase inhibitors(TKIs) plus programmed death-1 (PD-1) inhibitors [26,27] and locoregional treatments like hepatic arterial infusion chemotherapy (HAIC) plus TACE [28] have been explored as conversion therapies to induce tumor shrinkage or downstaging. As effective methods to introduce liver regeneration for patients with unmet future liver reserve(FLR), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) were deemed to be superior to portal vein embolization (PVE) in faster introduction of liver regeneration and fewer risk of tumor progression [29,30]. For patients who failed to achieve sufficient hypertrophy after conventional ALPPS stage-1 due to severe fibrosis/cirrhosis, transcatheter arterial embolization-salvaged ALPPS (TAE-salvaged ALPPS) was a new strategy to increase the resectability of HCC [31].…”

A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights

“…For patients with unmet future liver reserve (FLR), portal vein embolization (PVE) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are suggested as effective methods to induce liver regeneration. Recent studies recommend ALPPS over PVE in faster introduction of liver regeneration and fewer risk of tumor progression ( 34 , 35 ). On the other hand, the BCLC group insist on only patients with solitary HCC in the absence of clinically significant portal hypertension (CSPH) as optimal target population for hepatectomy ( 36 ).…”