Sequential Portal Vein Embolization and Percutaneous Radiofrequency Ablation for Future Liver Remnant Growth: A Minimally Invasive Alternative to ALPPS Stage-1 in Treatment of Hepatocellular Carcinoma
Sequential Portal Vein Embolization and Percutaneous Radiofrequency Ablation for Future Liver Remnant Growth: A Minimally Invasive Alternative to ALPPS Stage-1 in Treatment of Hepatocellular Carcinoma
Blog Article
Background: To evaluate the feasibility and efficacy of sequential portal vein embolization (PVE) and radiofrequency ablation (RFA) (PVE+RFA) as a minimally invasive variant for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) stage-1 in treatment of cirrhosis-related hepatocellular carcinoma (HCC).Methods: For HCC patients with insufficient FLR, right-sided PVE was first performed, followed by percutaneous RFA to the tumor as a means to trigger FLR growth.When the FLR reached a safe level (at least 40%) and the blood biochemistry tests were in good condition, the hepatectomy was performed.
FLR dynamic changes and serum biochemical tests were evaluated.
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.Postoperative complications, mortality, intraoperative data and long-term oncological outcome were also recorded.Results: Seven patients underwent PVE+RFA for FLR growth between March 2016 and December 2019.
The median baseline of FLR was 353 ml (28%), which increased to 539 (44%) ml after 8 (7–18) days of this strategy (p < 0.05).The increase of FLR ranged from 40% to 140% (median 47%).
Five patients completed hepatectomy.The median interval between PVE+RFA and hepatectomy was 19 (15–27) days.No major morbidity ≥ III of Clavien-Dindo classification or in-hospital mortality occurred.
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One patient who did not proceed to surgery died within 90 days after discharge.After a median follow-up of 18 (range 3–50) months, five patients were alive.Conclusion: Sequential PVE+RFA is a feasible and effective strategy for FLR growth prior to extended hepatectomy and may provide a minimally invasive alternative for ALPPS stage-1 for treatment of patients with cirrhosis-related HCC.