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Selective occlusion of the hepatic artery and portal vein improves liver hypertrophy for staged hepatectomy

Authors
  • Jia, Changku1
  • Ge, Ke1
  • Xu, Sunbing1
  • Liu, Ling1
  • Weng, Jie2
  • Chen, Youke2
  • 1 Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Zhejiang Clinical Research Center of Hepatobiliary and Pancreatic Diseases, Department of Hepatobiliary Pancreatic Surgery, No. 261, Huansha Road, Hangzhou, 310006, China , Hangzhou (China)
  • 2 The First Affiliated Hospital of Hainan Medical College, Department of Hepatobiliary Pancreatic Surgery, Haikou, 570102, China , Haikou (China)
Type
Published Article
Journal
World Journal of Surgical Oncology
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Oct 07, 2019
Volume
17
Issue
1
Identifiers
DOI: 10.1186/s12957-019-1710-9
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundTo evaluate the safety and feasibility of selective occlusion of the hepatic artery and portal vein (SOAP) for staged hepatectomy (SOAPS) in patients with hepatocellular carcinoma (HCC)MethodsFrom December 2014 to August 2018, 9 patients with unresectable HCC were chosen to undergo SOAPS. SOAP without liver partition was performed in the first stage. The second stage was performed when future liver remnant (FLR) was equal to or bigger than 40% of the standard liver volume (SLV). The growth rate of FLR, perioperative outcomes, and survival data was recorded.ResultsIn the first stage, all the 9 patients completed SOAP. Two cases received radiological interventional method and 7 cases received open operation. None of them developed liver failure and died following SOAP. After SOAP, FLR increased 145.0 ml (115.0 to 210 ml) and 37.1% (25.6 to 51.7%) on average. The average time interval between the two stages was 14.1 days (8 to 18 days). In the second stage, no in-hospital deaths occurred after SOAPS. One patient suffered from liver failure after SOAPS, and artificial liver support was adopted and his total bilirubin level returned to normal after postoperative day 35. The alpha-fetoprotein level of 8 patients reduced to normal within 2 months after SOAPS. Among 9 patients, 5 patients survived, 4 patients died of intrahepatic recurrence, lung metastasis, or bone metastasis. In the 5 survived cases, bone metastasis and intrahepatic recurrence were found in 1 patient, intrahepatic recurrence was found in another patient, and the remaining 3 patients were free of recurrence. The median disease-free survival time and overall survival time were 10.4 and 13.9 months, respectively.ConclusionSOAP can facilitate rapid and sustained FLR hypertrophy, and SOAPS is safe and effective in patients with unresectable HCC.

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