Tourniquet-ALPPS is a promising treatment for very large hepatocellular carcinoma and intrahepatic cholangiocarcinoma
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Victor López-López1, Ricardo Robles-Campos1, Robeto Brusadin1, Asunción López-Conesa1, Álvaro Navarro1, Julio Arevalo-Perez2, Pedro Jose Gil1 and Pascual Parrilla1
1Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
2Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
Ricardo Robles-Campos, email: [email protected]
Victor López-López, email: [email protected]
Keywords: hepatocarcinoma; intrahepatic cholangiocarcinoma; ALPPS; two-stage hepatectomy
Received: February 06, 2018 Accepted: May 12, 2018 Published: June 15, 2018
When very large hepatocellular carcinomas (HCCs) and intrahepatic cholangiocarcinoma (IHCCs) with insufficient future liver remnants are treated using associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), the outcome is often poor. We therefore tested the efficacy of a modified version of that technique, tourniquet-ALPPS. A review of the literature examining outcomes of HCC and IHCC patients treated with ALPPS revealed the incidences of morbidity ≥ III and postoperative mortality to be respectively 20.7% and 16.1% among HCC patients and 50% and 45.4% among IHCC patients. In the present case series, in which HCC and IHCC patients were treated with tourniquet-ALPPS, median tumor size was 100 mm (range: 70–200 mm). After surgical stage I, there was no morbidity, no mortality and the median future liver remnant had increased at day 7 by 76%. In surgical stage II, 100% of tumors were resectable (8 right trisectionectomies, 5 with inferior vena cava resection). Two patients experienced serious morbidity ≥ IIIB and 1 patient died (11%). One- and 3-year overall survival was 75% and 60%, respectively. Thus tourniquet-ALPPS appears to be an effective alternative to classical ALPPS for the treatment of patients with HCC or IHCC.
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