Failure to perform second-stage operation after first one of associating liver partition and portal vein ligation for staged hepatectomy: analysis of 62 cases

Abstract

Objective To summarize the clinical reasons for failing to perform the second stage of operation after the first stage of operation of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), and to explore the risk factors affecting the second stage of operation. Methods A sectional-cross study was conducted on 62 patients (54 males and 8 females, age: 49.1±10.4) with liver tumors who were continuously treated with ALPPS from October 2013 to December 2021. The patients were divided into the second stage of operation group and the non-second-stage operation group according to whether they accepted the second stage of operation or not. The clinical reasons why patients were failing to have the second stage of operation were collected. The data of patients, including the tumor diameter, clinical stages, Child-Pugh score, liver separation mode, liver function (levels of transaminase, bilirubin and albumin) in the preoperative and postoperative of first stage operation period, and complications were analyzed. Results Among the 62 patients, 45 patients successfully underwent the second stage of operation, and 17 patients failed to accept the second stage of operation, accounting for 27.4%. Among the patients who failed to accept the second stage of operation, there were 2 cases in the open ALPPS group, 11 cases in the radiofrequency assisted ALPPS (RALPS) group, and 4 cases in the laparoscopic ALPPS group. The difference of maximum tumor diameter and the formation of portal vein tumor thrombus was statistically significant (P < 0.05). In terms of liver function, the differences in the level of albumin and total bilirubin tested before the first stage of operation and the level of aspartate aminotransferase and total bilirubin tested after the first stage of operation were statistically significant(P < 0.05). Pulmonary inflammation, pleural effusion and ascites were common complications of the first stage operation. There was significant difference between the 2 groups in complications of ascites of the first stage of operation(P < 0.05). There was significant difference in the incidence of complications(≥grade Ⅲ) between the 2 groups (P < 0.001). The clinical causes that patients failed to accepted the second stage of operation were no obvious liver hyperplasia, insufficient future liver remnant volume (FLRV), poor liver function and hepatic reserve function, complications and progression of tumor. Multivariate analysis showed that the risk factors affecting the second stage of operation were the maximum tumor diameter, the formation of tumor thrombus and the grade of complications of the first stage operation. Conclusion ALPPS should be selected carefully for patients with large tumor and portal vein thrombosis.

Keywords

• associating liver partition and portal vein ligation for staged hepatectomy
• liver cancer
• future liver remnant volume
• influencing factors