The evolution of staged hepatectomy

AbstractBackground Post-hepatectomy liver failure is the most severe complication after major hepatectomies and it is associated with, to a great extent, an insufficient future liver remnant (FLR). We aim to describe our experience of how to increase the resectability for patients with borderline FLR. Methods I. Our experience including 1. with TACE as first step; 2 with PVE+HAE as first step; 3 with HAL+ intra-arterial catheter chemotherapy as first step. II traditional methods including 1 PVE; 2 Adam-Bismuth’s staged hepatectomy (SH) as first step 3 Jaeck’s SH as first step 4 Clavien’s SH as first step. III Modified ALPPS: It is modified in 3 aspects. 1 using liver hanging cathehter as a round-the-liver tournique to replace liver parenchyal tranection 2 laprascopic hepatectomy was employed in both first stege and second stage 3 radio-frequency to replace liver parenchyal tranection. Results: The 3 cases described as examples in our experience, underwent surgery 10 years, 14 years and 28 years ago respectively are still surviving, one of them completely free of cancer. The 3 cases with modified ALPPS are surviving, two of them free of cancer, one of them with cancer recurrence. Conclusion: The measures of staged hepatectomy may convert some none-resectable hepatoma into –resectable. ALPPS has ermerged as a promising new measure,yet complications should be carefully prevented. None-parenchymal-transection ALPPS can better prevent bile leak to yield better result. ALPPS can also dramatically increas FLR in cirrhotic liver.Commentateur: René ADAM