RESUMEN
BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been reported to be a new treatment strategy for patients with predicted small volumes of future liver remnant (FLR). ALPPS is associated with rapid hypertrophy of FLR but it has a high postoperative mortality and morbidity. Up to now, it is controversial to apply ALPPS in hepatocellular carcinoma, especially for patients with liver cirrhosis. METHODS: Between May 2014 and June 2015, consecutive patients who underwent ALPPS with hepatitis B-related hepatocellular carcinoma with cirrhosis carried out in our center were included into the study. Demographic characteristics, surgical outcomes, and pathological results were evaluated. Subsequently, follow-up was still in progress. RESULTS: The median operating time of the first (n = 12) and the second procedures (n = 10) were 285.0 and 212.5 minutes, respectively. The median blood loss were 200 and 800 mL for 2 stages of operations. The severe complication (≥IIIB) rates for the first and the second operations were 25.0% versus 40.0%, respectively. Six patients with too small future live remnant died of postoperative hepatic failure. On a median follow-up of 16 months of the 6 patients discharged, 4 patients were still alive and of 2 were disease-free. CONCLUSION: In terms of the feasibility and safety, this study showed that ALPPS in the treatment of hepatocellular carcinoma with insufficient future liver remnant might be a double-edged sword, and careful patients selected was proposed. Too small of FLR/SLV, less than 30%, is not recommended for ALPPS in liver with cirrhosis.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Carcinoma Hepatocelular/etiología , Femenino , Hepatectomía , Hepatitis B/complicaciones , Humanos , Cirrosis Hepática/etiología , Neoplasias Hepáticas/etiología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
This study aimed to investigate the effect of adjuvant therapy on the treatment of stage II pancreatic carcinomas. The clinical data of 139 cases of stage II pancreatic carcinoma were analyzed retrospectively. The overall 1-, 3-, and 5-year cumulative survival rates of 139 patients were 40%, 6%, and 3%, respectively, and the median survival time (MST) was 279 days. The MST was 399 days for those with adjuvant therapy, 210 days for those without adjuvant therapy, 390 days for the radical resection group, 270 days for the bypass operation and laparotomy group, and 132 days for the nonsurgical group. The adjuvant therapy could not prolong the survival time and decrease the liver metastasis rate of the patients with stage II carcinoma significantly in radical resection group (P>0.05). In the bypass operation and laparotomy group and nonsurgical group, the adjuvant therapy could improve the survival of the patients significantly (P<0.05); however, the survival rate was not significantly different among systemic venous chemotherapy, radiation therapy, interventional therapy, and combination therapy (P>0.05); or between gemcitabine (GEM) regimen and 5-fluorouracil regimen (P>0.05); or between GEM monotherapy and GEM combined with platinum/capecitabine (P>0.05). The proper adjuvant therapy can be suggested according to the general condition of the patients after radical resection for stage II pancreatic carcinoma. Chemotherapy combined with radiation should be applied actively for the patients whose cancerous tissues were not radically resected. The clinical efficacy of GEM combined with platinum/capecitabine is relatively better than GEM.