Laparoscopic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (L-ALPPS) After Conversion Therapy for BCLC-B Hepatocellular Carcinoma: A Video Article

作者全名："Wang, Jiaguo; Xu, Jie; Liu, Zuojin"

作者地址："[Wang, Jiaguo; Xu, Jie; Liu, Zuojin] Chongqing Med Univ, Dept Hepatobiliary Surg, Affiliated Hosp 2, Chongqing, Peoples R China"

通信作者："Liu, ZJ (通讯作者)，Chongqing Med Univ, Dept Hepatobiliary Surg, Affiliated Hosp 2, Chongqing, Peoples R China."

来源：ANNALS OF SURGICAL ONCOLOGY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001038560500003

JCR分区：Q1

影响因子：3.4

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：Laparoscopic liver resection; ALPPS; Hepatocellular carcinoma; Conversion therapy; Minimally invasive surgery

摘要："Background Despite the ALPPS technique remains a controversy, various ALPPS techniques have made many attempts.(1-6) This video discusses the technical tips for L-ALPPS after conversion therapy.Methods A 56-year-old, HCC patient who performed the abdominal CT showed a 6.0*5.7-cm-sized mass with intrahepatic metastasis. After four cycles of conversion therapy, the patient achieved a radiologic complete response. However, the standardized, remnant liver volume ratio (SRLVR) was only 34%. Thus, L-ALPPS was contemplated.Results After full mobilization, intraoperative ultrasonography marked the main trunk of MHV. The concept of ""Laennec membrane anatomy"" was introduced.(7) The anterior pedicle (AP) and the posterior pedicle (PP) were elastically suspended along the Laennec membrane. The conventional hilar dissection approach was used to isolate and suspend RHA and the right portal vein (RPV). Then, IRHV and short hepatic vein were clipped and cut. The Pringle maneuver was used intermittently during the parenchymal transection. Hepatic resection was performed from the caudal to the cranial side along MHV after RPV was ligated. The RHV was elastically suspended after hepatic resection. The omentum was used to cover the resection surface. Stage 2, preoperative SRLVR increased to 68.3%. The adhesion of the right hemiliver was bluntly separated. AP, PP, and RHV were divided by the stapler respectively. Operation time and bleeding volume for stage-1 surgery and stage-2 surgery were 240 min and 80 min, 200 ml and 250 ml, respectively. The postoperative recovery was uneventful.Conclusions L-ALPPS as a surgical option seems to be feasible and safe for intermediate-advanced HCC after conversion therapy."

基金机构：National Natural Science Foundation of China [82070678]

基金资助正文：This work was supported by the National Natural Science Foundation of China (No.82070678).