Ann Surg Treat Res.  2016 May;90(5):287-291. 10.4174/astr.2016.90.5.287.

Associating microwave ablation and portal vein ligation for staged hepatectomy for the treatment of huge hepatocellular carcinoma with cirrhosis

• Chen JX
• Ran HQ
• Sun CQ

• KMID: 2163069
• DOI: http://doi.org/10.4174/astr.2016.90.5.287

Abstract

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) could induce extensive and rapid future liver remnant hypertrophy. However, the morbidity for ALPPS is very high. This paper reports a modified ALPPS (associating microwave ablation and portal vein ligation for staged hepatectomy, AMAPS), which was successfully applied in the treatment of huge hepatocellular carcinoma with cirrhosis, and the procedure of operation was greatly simplified. Hence, AMAPS is feasible and safe in selected patients with primary hepatocellular carcinoma and cirrhosis.

Keyword

Hepatectomy; Hepatocellular carcinoma; Liver cirrhosis

MeSH Terms

Carcinoma, Hepatocellular*
Fibrosis*
Hepatectomy*
Humans
Hypertrophy
Ligation*
Liver
Liver Cirrhosis
Microwaves*
Portal Vein*

Figure

• 

  Fig. 1 The preoperative CT scan showed a huge hepatocellular carcinoma in the right liver (red arrow), and a typical hemangioma in the left liver (green arrow). (A) The plain CT scan. (B) The hepatic arterial phase. (C) The portal venous phase. (D) The equilibrium phase.

• 

  Fig. 2 Surgical procedure. (A) The hepatic pedicle was dissected, the right hepatic artery (red arrow) and theright portal vein (blue arrow) were isolated in the first-stage operation respectively. (B) The right hepaticartery was tagged by the homemade rubber strip in the first-stage operation (green arrow). (C) Themicrowave ablated the future transection plane with the ultrasound-guided in the firststage operation. (D) The bloodless blunt liver resection in the second-stage operation.

• 

  Fig. 3 Comparison of the future liver remnant at different time after the first-stage operation. (A) The preoperative CT image. (B) The image after 1 week. (C) The image after 2 weeks. (D) The image after 20 days. All images were at the same layer with the marker of hemangioma in the left liver (green arrow).

• 

  Fig. 4 Follow-up computed tomography scan 3 months later showed no recurrence or metastasis. The left liver lesion with high density was hemangioma (green arrow). (A) The plain CT scan. (B) The hepatic arterial phase. (C) The portal venous phase. (D) The equilibrium phase.

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