Application of multi-disciplinary team model in associating liver partition and portal vein ligation for staged hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Qujin , LIU Zuojin , TU Bing , GONG Jianping ,  LIU Jiao

Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding?author：

LIU Jiao, Email: ljlovey@163.com

Keywords：

multi-disciplinary team model; huge primary liver cancer; associating liver partition and portal vein occlusion for staged hepatectomy

DOI：

10.7507/1007-9424.201802055

Video：

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Objective To explore application value of multi-disciplinary team (MDT) model in patient underwent associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS). Methods A huge mass of liver right lobe about 90.9 mm×75.5 mm×77.5 mm was found by the preoperative abdominal CT examination, which was considered as the primary liver cancer. The ALPPS was decided to perform through the discussion by the Departments of Radiology, Anesthesiology, Infectious disease, Oncology, and Hepatobiliary surgery. The first step operation included the exploratory laparotomy, associating ligation of the right branch of portal vein and disconnection of left and right hemi liver, radiofrequency ablation, and cholecystectomy. The second step operation was performed at 45 d after the first step operation, which included the release of the abdominal adhesion and the resection of the right lobe of liver. Results During the period of the two steps surgeries, though the patient had the liver failure, hepatic encephalopathy, and poor proliferation of the left lobe of liver, and so on, the ALPPS was finished smoothly and the R0 resection was achieved through the collboration of MDT. After the surgery, the related complications were treated by the MDT, the patient got great recovery and no recurrence or metastasis occurred during the following-up. Conclusion It is feasible to use ALPPS in treatment of primary giant liver cancer under MDT model, it will be more conducive to clinical brainstorming for the best treatment and better income of patient.

Citation： LI Qujin, LIU Zuojin, TU Bing, GONG Jianping, LIU Jiao. Application of multi-disciplinary team model in associating liver partition and portal vein ligation for staged hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(7): 852-858. doi: 10.7507/1007-9424.201802055 Copy

1.	曹霖, 汪曉東, 李立. 多學科協作診治模式的會診流程探討(一). 中國普外基礎與臨床雜志, 2007, 14(3): 343-345.
2.	Kurpad R, Kim W, Rathmell WK, et al. A multidisciplinary approach to the management of urologic malignancies: does it influence diagnostic and treatment decisions? Urol Oncol, 2011, 29(4): 378-382.
3.	徐文杰, 曹剛, 張根山, 等. 聚乙烯醇栓塞微球可載藥微球介入治療中晚期肝癌的臨床療效及安全性觀察. 實用癌癥雜志, 2017, 32(12): 1999-2001.
4.	Tanaka K, Matsuo K, Murakami T, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity. Eur J Surg Oncol, 2015, 41(4): 506-512.
5.	Schadde E, Raptis DA, Schnitzbauer AA, et al. Prediction of mortality after ALPPS stage-1: an analysis of 320 patients from the International ALPPS Registry. Ann Surg, 2015, 262(5): 780-785.
6.	Bertens KA, Hawel J, Lung K, et al. ALPPS: challenging the concept of unresectability—a systematic review. Int J Surg, 2015, 13: 280-287.
7.	Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): E359-E386.
8.	黃鏡. 肝細胞癌免疫治療進展. 中華醫學雜志, 2017, 97(45): 3597-3600.
9.	黃乾榮, 張玲. 原發性肝癌治療研究新進展. 實用醫學雜志, 2016, 32(14): 2275-2278.
10.	Baumgart J, Lang S, Lang H. A new method for induction of liver hypertrophy prior to right trisectioncctomy: a report of three cases. HPB (Oxford), 2011, 13(suppl 2): 1-145.
11.	Schadde E, Ardiles V, Robles-Campos R, et al. Early survival and safety of ALPPS: first report of the International ALPPS Registry. Ann Surg, 2014, 260(5): 829-836.
12.	Croome KP, Hernandez-Alejandro R, Parker M, et al. Is the liver kinetic growth rate in ALPPS unprecedented when compared with PVE and living donor liver transplant? A multicentre analysis. HPB (Oxford), 2015, 17(6): 477-484.
13.	Tanaka K, Matsuo K, Murakami T, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity. Eur J Surg Oncol, 2015, 41(4): 506-512.
14.	Gauzolino R, Castagnet M, Blanleuil ML, et al. The ALPPS technique for bilateral colorectal metastases: three " variations on a theme”. Updates Surg, 2013, 65(2): 141-148.
15.	Gall TM, Sodergren MH, Frampton AE, et al. Radio-frequency-assisted liver partition with portal vein ligation (RALPP) for liver regeneration. Ann Surg, 2015, 261(2): e45-e46.
16.	鄭捷. 肝切除術后肝再生調控機制的研究進展. 醫學理論與實踐, 2014, (18): 2414-2415.
17.	呂璟. 肝再生相關細胞因子的探究. 解剖科學進展, 2005, 11(2): 174-179.
18.	李紅蕾, 陳曉光, 張富春, 等. 細胞外基質相關基因在大鼠肝再生中表達模式分析. 遺傳, 2008, 30(3): 333-340.
19.	Koniaris LG, McKillop IH, Schwartz SI, et al. Liver regeneration. J Am Coll Surg, 2003, 197(4): 634-659.
20.	Torres OJ, Moraes-Junior JM, Lima e Lima NC, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): a new approach in liver resections. Arq Bras Cir Dig, 2012, 25(4): 290-292.
21.	Li J, Girotti P, K?nigsrainer I, et al. ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure? J Gastrointest Surg, 2013, 17(5): 956-961.
22.	Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended fight hepatic resection in small-for-size settings. Ann Surg, 2012, 255(3): 405-414．.
23.	黃拼搏, 胡志剛, 許僑東, 等. ALPPS 在具有乙肝肝硬化背景的巨塊型肝癌中的應用. 嶺南現代臨床外科, 2015, 15(5): 527-532.
24.	Chan AC, Poon RT, Chan C, et al. Safety of ALPPS procedure by the anterior approach for hepatocellular carcinoma. Ann Surg, 2016, 263(2): e14-e16.
25.	張金山, 饒丹, 王鋼勝. 腹腔鏡下 ALPPS 治療肝癌的臨床效果分析. 中華普外科手術學雜志(電子版), 2017, 11(3): 210-213.

1. 曹霖, 汪曉東, 李立. 多學科協作診治模式的會診流程探討(一). 中國普外基礎與臨床雜志, 2007, 14(3): 343-345.
2. Kurpad R, Kim W, Rathmell WK, et al. A multidisciplinary approach to the management of urologic malignancies: does it influence diagnostic and treatment decisions? Urol Oncol, 2011, 29(4): 378-382.
3. 徐文杰, 曹剛, 張根山, 等. 聚乙烯醇栓塞微球可載藥微球介入治療中晚期肝癌的臨床療效及安全性觀察. 實用癌癥雜志, 2017, 32(12): 1999-2001.
4. Tanaka K, Matsuo K, Murakami T, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity. Eur J Surg Oncol, 2015, 41(4): 506-512.
5. Schadde E, Raptis DA, Schnitzbauer AA, et al. Prediction of mortality after ALPPS stage-1: an analysis of 320 patients from the International ALPPS Registry. Ann Surg, 2015, 262(5): 780-785.
6. Bertens KA, Hawel J, Lung K, et al. ALPPS: challenging the concept of unresectability—a systematic review. Int J Surg, 2015, 13: 280-287.
7. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 2015, 136(5): E359-E386.
8. 黃鏡. 肝細胞癌免疫治療進展. 中華醫學雜志, 2017, 97(45): 3597-3600.
9. 黃乾榮, 張玲. 原發性肝癌治療研究新進展. 實用醫學雜志, 2016, 32(14): 2275-2278.
10. Baumgart J, Lang S, Lang H. A new method for induction of liver hypertrophy prior to right trisectioncctomy: a report of three cases. HPB (Oxford), 2011, 13(suppl 2): 1-145.
11. Schadde E, Ardiles V, Robles-Campos R, et al. Early survival and safety of ALPPS: first report of the International ALPPS Registry. Ann Surg, 2014, 260(5): 829-836.
12. Croome KP, Hernandez-Alejandro R, Parker M, et al. Is the liver kinetic growth rate in ALPPS unprecedented when compared with PVE and living donor liver transplant? A multicentre analysis. HPB (Oxford), 2015, 17(6): 477-484.
13. Tanaka K, Matsuo K, Murakami T, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity. Eur J Surg Oncol, 2015, 41(4): 506-512.
14. Gauzolino R, Castagnet M, Blanleuil ML, et al. The ALPPS technique for bilateral colorectal metastases: three " variations on a theme”. Updates Surg, 2013, 65(2): 141-148.
15. Gall TM, Sodergren MH, Frampton AE, et al. Radio-frequency-assisted liver partition with portal vein ligation (RALPP) for liver regeneration. Ann Surg, 2015, 261(2): e45-e46.
16. 鄭捷. 肝切除術后肝再生調控機制的研究進展. 醫學理論與實踐, 2014, (18): 2414-2415.
17. 呂璟. 肝再生相關細胞因子的探究. 解剖科學進展, 2005, 11(2): 174-179.
18. 李紅蕾, 陳曉光, 張富春, 等. 細胞外基質相關基因在大鼠肝再生中表達模式分析. 遺傳, 2008, 30(3): 333-340.
19. Koniaris LG, McKillop IH, Schwartz SI, et al. Liver regeneration. J Am Coll Surg, 2003, 197(4): 634-659.
20. Torres OJ, Moraes-Junior JM, Lima e Lima NC, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): a new approach in liver resections. Arq Bras Cir Dig, 2012, 25(4): 290-292.
21. Li J, Girotti P, K?nigsrainer I, et al. ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure? J Gastrointest Surg, 2013, 17(5): 956-961.
22. Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended fight hepatic resection in small-for-size settings. Ann Surg, 2012, 255(3): 405-414．.
23. 黃拼搏, 胡志剛, 許僑東, 等. ALPPS 在具有乙肝肝硬化背景的巨塊型肝癌中的應用. 嶺南現代臨床外科, 2015, 15(5): 527-532.
24. Chan AC, Poon RT, Chan C, et al. Safety of ALPPS procedure by the anterior approach for hepatocellular carcinoma. Ann Surg, 2016, 263(2): e14-e16.
25. 張金山, 饒丹, 王鋼勝. 腹腔鏡下 ALPPS 治療肝癌的臨床效果分析. 中華普外科手術學雜志(電子版), 2017, 11(3): 210-213.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of multi-disciplinary team model in associating liver partition and portal vein ligation for staged hepatectomy

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