Two-step liver resection in treatment of advanced hepatic alveolar echinococcosis: Safety and efficacy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XING Hongming ^1,2 , HUANG Jianhua ^1,3 , YOU Xinyu ^1,3 , LIAO Yubo ⁴ ,  ZHANG Yu ^1,2

1. Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;
2. Medical School of University of Electronic Science and Technology of China, Chengdu 610054, P. R. China;
3. Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
4. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, P. R. China;

Corresponding?author：

ZHANG Yu, Email: zhangyuqg@med.uestc.edu.cn

Keywords：

hepatic echinococcosis; liver hydatid disease; portal vein embolization; liver vein deprivation; associating liver partition and portal vein ligation for staged hepatectomy; ALPPS; liver regeneration; two-step hepatectomy

DOI：

10.7507/1007-9424.202407101

Video：

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Objective To explore the safety and efficacy of preoperative liver regeneration and then two-stage liver resection for advanced hepatic alveolar echinococcosis (HAE) patients pre-evaluating insufficient future liver remnant (FLR) after resection. Method The clinical data of the advanced HAE patients who were expected to have insufficient FLR after liver resection and underwent two-step liver resection in the Sichuan Provincial People’s Hospital from December 2016 to December 2022 were retrospectively collected and summarized. Results A total of 11 patients with advanced HAE pathologically confirmed were collected. Among them, 2 cases underwent portal vein embolization (PVE), 2 cases underwent liver vein deprivation (LVD), and 7 cases underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to promote residual liver regeneration in the first stage. The FLR/standard liver volume (SLV) exceeded the surgical requirement standard of 40%. Then the ex-vivo liver resection and autotransplantation, or directly radical liver resection was performed in the second stage. Only one patient underwent surgery to remove packed gauze on day 3 postoperatively due to massive intraoperative bleeding (approximately 4 000 mL). The median (P₂₅, P₇₅) follow-up time after surgery was 36 (15, 75) months, only one case was found to relapse at the third year after surgery and underwent surgical resection again, and the rest patients had no recurrence, long-term complications, or death. Conclusions Based on the results from these cases, applying PVE, LVD, or ALPPS in the patients with advanced HAE who were expected to have insufficient FLR after resection aids to residual liver regeneration, creating conditions for the second stage radical resection. The second stage treatment including ex-vivo liver resection and autotransplantation or directly radical liver resection could achieve good results and is feasible and safe, which brings a hope of survival for the advanced HAE patients who could not previously undergo curative resection. However, this treatment strategy still incurs high costs and requires further optimization in the future.

Citation： XING Hongming, HUANG Jianhua, YOU Xinyu, LIAO Yubo, ZHANG Yu. Two-step liver resection in treatment of advanced hepatic alveolar echinococcosis: Safety and efficacy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(10): 1202-1209. doi: 10.7507/1007-9424.202407101 Copy

1.	溫浩. 包蟲病學. 北京: 人民衛生出版社, 2015.
2.	四川省包蟲病臨床醫學研究中心, 四川省醫師協會包蟲病專業委員會. 泡型肝包蟲病診療專家共識(2020版). 中國普外基礎與臨床雜志, 2020, 27(1): 13-17.
3.	王永珍, 韓秀敏, 郭亞民. 肝包蟲病的診斷與治療研究進展. 寄生蟲病與感染性疾病, 2018, 16(1): 47-51.
4.	Periago MV. Special issue: “Echinococcosis”. Parasitologia, 2023, 3: 13-14.
5.	Tang JC, Suolang WJ, Yang C, et al. Monosegmental ALPPS combined with ante-situm liver resection: A novel strategy for end-stage hepatic alveolar echinococcosis. Hepatobiliary Pancreat Dis Int, 2022, 21(2): 186-189.
6.	Craig PS, Giraudoux P, Wang ZH, et al. Echinococcosis transmission on the Tibetan Plateau. Adv Parasitol, 2019, 104: 165-246.
7.	張宇, 楊沖, 王燚, 等. 離體肝切除和自體肝移植聯合復雜肝靜脈重建治療終末期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2018, 25(10): 1236-1241.
8.	楊文昊, 廖玉波, 黃良, 等. “在體優先”的離體肝切除聯合自體肝移植術治療晚期肝泡型包蟲病的應用效果. 中國普外基礎與臨床雜志, 2022, 29(10): 1308-1312.
9.	Liska V, Treska V, Mírka H, et al. Portal vein embolization—increased chance for liver resecability for malignancies. Rozhl Chir, 2007, 86(2): 97-102.
10.	Amer A, Wilson CH, Manas DM. Liver transplantation for unresectable malignancies: Beyond hepatocellular carcinoma. Eur J Surg Oncol, 2019, 45(12): 2268-2278.
11.	Kawano F, Mise Y, Yamamoto J, et al. Hepatic vein resection and reconstruction for liver malignancies: expanding indication and enhancing parenchyma-sparing hepatectomy. BJS Open, 2021, 5(6): zrab121. doi: 10.1093/bjsopen/zrab121.
12.	中國醫師協會外科醫師分會包蟲病外科專業委員會. 肝兩型包蟲病診斷與治療專家共識(2019版). 中華消化外科雜志, 2019, 18(8): 711-721.
13.	Maimaitinijiati Y, Meng Y, Chen X. Is long-term follow-up without surgical treatment a valid option for hepatic alveolar echinococcosis?. World J Gastroenterol, 2022, 28(24): 2775-2777.
14.	吐爾干艾力·阿吉, 邵英梅, 趙晉明, 等. 肝泡型包蟲病自體肝移植中提升功能肝“量與質”的臨床實踐: 附12例臨床病例分析. 中華醫學雜志, 2017, 97(4): 270-275.
15.	胡智明. 肝癌轉化治療策略. 中華肝膽外科雜志, 2023, 29(6): 401-405.
16.	Le Roy B, Gagnière J, Chabrot P, et al. Non-lethal right liver atrophy after TIPS occlusion in A cirrhotic patient: introducing the hepatic biembolization. J Gastrointest Surg, 2016, 20(9): 1671-1672.
17.	Guiu B, Chevallier P, Denys A, et al. Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol, 2016, 26(12): 4259-4267.
18.	Chebaro A, Buc E, Durin T, et al. Liver venous deprivation or associating liver partition and portal vein ligation for staged hepatectomy?: A retrospective multicentric study. Ann Surg, 2021, 274(5): 874-880.
19.	Guiu B, Quenet F, Panaro F, et al. Liver venous deprivation versus portal vein embolization before major hepatectomy: future liver remnant volumetric and functional changes. Hepatobiliary Surg Nutr, 2020, 9(5): 564-576.
20.	Liu T, Huang L, Liu J, et al. Liver vein deprivation combined with two-step hepatectomy for the treatment of advanced hepatic alveolar echinococcosis with remnant liver volume deficiency. Asian J Surg, 2024, 47(5): 2397-2398.
21.	Martin D, Labgaa I, Uldry E, et al. Preoperative liver venous deprivation. Revue Médicale Suisse, 2021, 17(743): 1150-1154.
22.	Oldhafer KJ, Stavrou GA, van Gulik TM, et al. ALPPS—Where do we stand, where do we go?: Eight recommendations from the First International Expert Meeting. Ann Surg, 2016, 263(5): 839-841.
23.	de Santiba?es E, Clavien PA. Playing Play-Doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg, 2012, 255(3): 415-417.
24.	Heil J, Korenblik R, Heid F, et al. Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis. Br J Surg, 2021, 108(7): 834-842.
25.	Akbulut S, Cicek E, Kolu M, et al. Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis: First case report in the literature. World J Gastrointest Surg, 2018, 10(1): 1-5.
26.	Schadde E, Malagó M, Hernandez-Alejandro R, et al. Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy. Surgery, 2015, 157(4): 676-689.
27.	唐幾超, 楊沖, 周果, 等. 變異ALPPS聯合下腔靜脈重建治療晚期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2020, 27(9): 1139-1144.
28.	Matsuo K, Murakami T, Kawaguchi D, et al. Histologic features after surgery associating liver partition and portal vein ligation for staged hepatectomy versus those after hepatectomy with portal vein embolization. Surgery, 2016, 159(5): 1289-1298.
29.	Kambakamba P, Stocker D, Reiner CS, et al. Liver kinetic growth rate predicts postoperative liver failure after ALPPS. HPB (Oxford), 2016, 18(10): 800-805.
30.	廖陽, 李生偉. 聯合肝臟離斷和門靜脈結扎二步肝切除術治療結直腸癌肝轉移的研究現狀. 臨床肝膽病雜志, 2019, 35(12): 2805-2808.
31.	楊沖, 楊洪吉, 鄧紹平, 等. 剩余肝體積不足的晚期肝泡型包蟲外科治療進展. 中國普通外科雜志, 2021, 30(1): 98-104.

1. 溫浩. 包蟲病學. 北京: 人民衛生出版社, 2015.
2. 四川省包蟲病臨床醫學研究中心, 四川省醫師協會包蟲病專業委員會. 泡型肝包蟲病診療專家共識(2020版). 中國普外基礎與臨床雜志, 2020, 27(1): 13-17.
3. 王永珍, 韓秀敏, 郭亞民. 肝包蟲病的診斷與治療研究進展. 寄生蟲病與感染性疾病, 2018, 16(1): 47-51.
4. Periago MV. Special issue: “Echinococcosis”. Parasitologia, 2023, 3: 13-14.
5. Tang JC, Suolang WJ, Yang C, et al. Monosegmental ALPPS combined with ante-situm liver resection: A novel strategy for end-stage hepatic alveolar echinococcosis. Hepatobiliary Pancreat Dis Int, 2022, 21(2): 186-189.
6. Craig PS, Giraudoux P, Wang ZH, et al. Echinococcosis transmission on the Tibetan Plateau. Adv Parasitol, 2019, 104: 165-246.
7. 張宇, 楊沖, 王燚, 等. 離體肝切除和自體肝移植聯合復雜肝靜脈重建治療終末期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2018, 25(10): 1236-1241.
8. 楊文昊, 廖玉波, 黃良, 等. “在體優先”的離體肝切除聯合自體肝移植術治療晚期肝泡型包蟲病的應用效果. 中國普外基礎與臨床雜志, 2022, 29(10): 1308-1312.
9. Liska V, Treska V, Mírka H, et al. Portal vein embolization—increased chance for liver resecability for malignancies. Rozhl Chir, 2007, 86(2): 97-102.
10. Amer A, Wilson CH, Manas DM. Liver transplantation for unresectable malignancies: Beyond hepatocellular carcinoma. Eur J Surg Oncol, 2019, 45(12): 2268-2278.
11. Kawano F, Mise Y, Yamamoto J, et al. Hepatic vein resection and reconstruction for liver malignancies: expanding indication and enhancing parenchyma-sparing hepatectomy. BJS Open, 2021, 5(6): zrab121. doi: 10.1093/bjsopen/zrab121.
12. 中國醫師協會外科醫師分會包蟲病外科專業委員會. 肝兩型包蟲病診斷與治療專家共識(2019版). 中華消化外科雜志, 2019, 18(8): 711-721.
13. Maimaitinijiati Y, Meng Y, Chen X. Is long-term follow-up without surgical treatment a valid option for hepatic alveolar echinococcosis?. World J Gastroenterol, 2022, 28(24): 2775-2777.
14. 吐爾干艾力·阿吉, 邵英梅, 趙晉明, 等. 肝泡型包蟲病自體肝移植中提升功能肝“量與質”的臨床實踐: 附12例臨床病例分析. 中華醫學雜志, 2017, 97(4): 270-275.
15. 胡智明. 肝癌轉化治療策略. 中華肝膽外科雜志, 2023, 29(6): 401-405.
16. Le Roy B, Gagnière J, Chabrot P, et al. Non-lethal right liver atrophy after TIPS occlusion in A cirrhotic patient: introducing the hepatic biembolization. J Gastrointest Surg, 2016, 20(9): 1671-1672.
17. Guiu B, Chevallier P, Denys A, et al. Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol, 2016, 26(12): 4259-4267.
18. Chebaro A, Buc E, Durin T, et al. Liver venous deprivation or associating liver partition and portal vein ligation for staged hepatectomy?: A retrospective multicentric study. Ann Surg, 2021, 274(5): 874-880.
19. Guiu B, Quenet F, Panaro F, et al. Liver venous deprivation versus portal vein embolization before major hepatectomy: future liver remnant volumetric and functional changes. Hepatobiliary Surg Nutr, 2020, 9(5): 564-576.
20. Liu T, Huang L, Liu J, et al. Liver vein deprivation combined with two-step hepatectomy for the treatment of advanced hepatic alveolar echinococcosis with remnant liver volume deficiency. Asian J Surg, 2024, 47(5): 2397-2398.
21. Martin D, Labgaa I, Uldry E, et al. Preoperative liver venous deprivation. Revue Médicale Suisse, 2021, 17(743): 1150-1154.
22. Oldhafer KJ, Stavrou GA, van Gulik TM, et al. ALPPS—Where do we stand, where do we go?: Eight recommendations from the First International Expert Meeting. Ann Surg, 2016, 263(5): 839-841.
23. de Santiba?es E, Clavien PA. Playing Play-Doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg, 2012, 255(3): 415-417.
24. Heil J, Korenblik R, Heid F, et al. Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis. Br J Surg, 2021, 108(7): 834-842.
25. Akbulut S, Cicek E, Kolu M, et al. Associating liver partition and portal vein ligation for staged hepatectomy for extensive alveolar echinococcosis: First case report in the literature. World J Gastrointest Surg, 2018, 10(1): 1-5.
26. Schadde E, Malagó M, Hernandez-Alejandro R, et al. Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy. Surgery, 2015, 157(4): 676-689.
27. 唐幾超, 楊沖, 周果, 等. 變異ALPPS聯合下腔靜脈重建治療晚期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2020, 27(9): 1139-1144.
28. Matsuo K, Murakami T, Kawaguchi D, et al. Histologic features after surgery associating liver partition and portal vein ligation for staged hepatectomy versus those after hepatectomy with portal vein embolization. Surgery, 2016, 159(5): 1289-1298.
29. Kambakamba P, Stocker D, Reiner CS, et al. Liver kinetic growth rate predicts postoperative liver failure after ALPPS. HPB (Oxford), 2016, 18(10): 800-805.
30. 廖陽, 李生偉. 聯合肝臟離斷和門靜脈結扎二步肝切除術治療結直腸癌肝轉移的研究現狀. 臨床肝膽病雜志, 2019, 35(12): 2805-2808.
31. 楊沖, 楊洪吉, 鄧紹平, 等. 剩余肝體積不足的晚期肝泡型包蟲外科治療進展. 中國普通外科雜志, 2021, 30(1): 98-104.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Two-step liver resection in treatment of advanced hepatic alveolar echinococcosis: Safety and efficacy

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