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Totally laparoscopic ALPPS combined with the microwave ablation for a patient with a huge HCC

Hua Zhang. Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University

Introduction: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel technique for resecting hepatic tumors that were previously considered unresectable due to the insufficient future liver remnant (FLR) which may result in postoperative liver failure (PLF). The procedure has been accepted and modified in many medical centers worldwide. But reports about the laparoscopic ALPPS were rare. This study aimed to report a totally ALPPS combined with microwave ablation for a patient with huge HCC and confirm the feasibility of laparoscopic ALPPS.

Methods: A 51-year-old man had complained of 1-year history of right upper abdominal pain, and the syndrome was worsened in recent month. Abdominal enhanced computed tomography (CT) imaging revealed a 15 ×11 cm solid mass in right lobe of liver with non-uniform and unclear boundary, the right posterior branch of the portal vein was invaded. In addition, a small lesion was simultaneous found in left lateral lobe of liver. The tumor was evaluated as unresectable due to the FLR was only 355ml (25%). We decided to perform the laparoscopic ALPPS procedure. First stage including microwave ablation of the lesion in left lobe, cholecystectomy, ligation of the portal vein and transection of liver parenchyma. The second stage was done 11 days later and consisted of laparoscopic right hemihepatectomy.

Results: The two stages were underwent by laparoscopy successfully. The operation duration was 300 and 200 minutes, respectively. Estimated blood loss was 550 and 250 ml. The hospitalization time in intensive care unit was 1 and 3 days. There was no need for transfusion in both stages. The patient was discharged 22 days after the second stage and the total hospitalization time was 38 days. Recovery of the patient was uneventful in addition to the incision infection after the second stage which recovered with conservative management. The patient did not show any signs of liver failure. The CT scan before the second stage showed an enlargement of left lobe, the FLR was 533 ml (37.5%). There was no signs of residual liver disease in the CT scan 10 days after the operation. The patient showed no signs of recurrence or liver failure in the following up period of six months.

Conclusion: Totally laparoscopic ALPPS combined with microwave ablation is safe and feasible for the multiple HCC which was not resectable. The hypertrophy of remaining liver was fast and can achieve an adequate volume in a short time. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87254

Program Number: P132

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

43

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