Large hepatocellular carcinoma conquered by ALPPS: a case report
Abstract Background The only means of achieving long-term survival in hepatocellular carcinoma (HCC) beyond transplant criteria is complete tumour resection. The limiting factor for curative resection in large HCC is an inadequate future liver remnant (FLR) that might culminate into post hepatectomy...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-08-01
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| Series: | Egyptian Liver Journal |
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| Online Access: | http://link.springer.com/article/10.1186/s43066-020-00048-6 |
| _version_ | 1818047952300539904 |
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| author | Nagari Bheerappa Digvijoy Sharma Gangadhar Rao Gondu Nirjhar Raj Kamal Kishore Bishnoi |
| author_facet | Nagari Bheerappa Digvijoy Sharma Gangadhar Rao Gondu Nirjhar Raj Kamal Kishore Bishnoi |
| author_sort | Nagari Bheerappa |
| collection | DOAJ |
| description | Abstract Background The only means of achieving long-term survival in hepatocellular carcinoma (HCC) beyond transplant criteria is complete tumour resection. The limiting factor for curative resection in large HCC is an inadequate future liver remnant (FLR) that might culminate into post hepatectomy liver failure (PHLF). The most common method that has been employed thus far to increase the FLR is portal vein embolization (PVE), which has its own set of drawbacks mainly inadequate hypertrophy, longer duration to achieve adequate FLR and tumour progression in the waiting period. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel upcoming technique that aids in achieving rapid hypertrophy of FLR, thereby facilitating resection of an otherwise unresectable tumour. Case presentation The authors present a case of a 46-year-old female with non-metastatic large HCC with inadequate FLR unsuitable for upfront hepatectomy. A two-stage surgical resection with ALPPS technique was preferred over PVE in this patient. This facilitated early hypertrophy of FLR and complete surgical resection of the tumour was performed successfully with an uneventful perioperative period. The patient was disease free at 16 months of follow-up. Conclusion ALPPS is a feasible option for otherwise unresectable large HCCs in carefully selected patients with acceptable morbidity. |
| first_indexed | 2024-12-10T10:13:58Z |
| format | Article |
| id | doaj.art-6884482f1fe54224ae49e39cbf69afd1 |
| institution | Directory Open Access Journal |
| issn | 2090-6226 |
| language | English |
| last_indexed | 2024-12-10T10:13:58Z |
| publishDate | 2020-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Egyptian Liver Journal |
| spelling | doaj.art-6884482f1fe54224ae49e39cbf69afd12022-12-22T01:53:03ZengSpringerOpenEgyptian Liver Journal2090-62262020-08-011011410.1186/s43066-020-00048-6Large hepatocellular carcinoma conquered by ALPPS: a case reportNagari Bheerappa0Digvijoy Sharma1Gangadhar Rao Gondu2Nirjhar Raj3Kamal Kishore Bishnoi4Department of Surgical Gastroenterology, Nizams Institute of Medical SciencesDepartment of Surgical Gastroenterology, Nizams Institute of Medical SciencesDepartment of Surgical Gastroenterology, Nizams Institute of Medical SciencesDepartment of Surgical Gastroenterology, Nizams Institute of Medical SciencesDepartment of Surgical Gastroenterology, Nizams Institute of Medical SciencesAbstract Background The only means of achieving long-term survival in hepatocellular carcinoma (HCC) beyond transplant criteria is complete tumour resection. The limiting factor for curative resection in large HCC is an inadequate future liver remnant (FLR) that might culminate into post hepatectomy liver failure (PHLF). The most common method that has been employed thus far to increase the FLR is portal vein embolization (PVE), which has its own set of drawbacks mainly inadequate hypertrophy, longer duration to achieve adequate FLR and tumour progression in the waiting period. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel upcoming technique that aids in achieving rapid hypertrophy of FLR, thereby facilitating resection of an otherwise unresectable tumour. Case presentation The authors present a case of a 46-year-old female with non-metastatic large HCC with inadequate FLR unsuitable for upfront hepatectomy. A two-stage surgical resection with ALPPS technique was preferred over PVE in this patient. This facilitated early hypertrophy of FLR and complete surgical resection of the tumour was performed successfully with an uneventful perioperative period. The patient was disease free at 16 months of follow-up. Conclusion ALPPS is a feasible option for otherwise unresectable large HCCs in carefully selected patients with acceptable morbidity.http://link.springer.com/article/10.1186/s43066-020-00048-6HCC (hepatocellular carcinoma)ALPPS (associating liver partition and portal vein ligation for staged hepatectomy)FLR (future liver remnant)PVE (portal vein embolization) |
| spellingShingle | Nagari Bheerappa Digvijoy Sharma Gangadhar Rao Gondu Nirjhar Raj Kamal Kishore Bishnoi Large hepatocellular carcinoma conquered by ALPPS: a case report Egyptian Liver Journal HCC (hepatocellular carcinoma) ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) FLR (future liver remnant) PVE (portal vein embolization) |
| title | Large hepatocellular carcinoma conquered by ALPPS: a case report |
| title_full | Large hepatocellular carcinoma conquered by ALPPS: a case report |
| title_fullStr | Large hepatocellular carcinoma conquered by ALPPS: a case report |
| title_full_unstemmed | Large hepatocellular carcinoma conquered by ALPPS: a case report |
| title_short | Large hepatocellular carcinoma conquered by ALPPS: a case report |
| title_sort | large hepatocellular carcinoma conquered by alpps a case report |
| topic | HCC (hepatocellular carcinoma) ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) FLR (future liver remnant) PVE (portal vein embolization) |
| url | http://link.springer.com/article/10.1186/s43066-020-00048-6 |
| work_keys_str_mv | AT nagaribheerappa largehepatocellularcarcinomaconqueredbyalppsacasereport AT digvijoysharma largehepatocellularcarcinomaconqueredbyalppsacasereport AT gangadharraogondu largehepatocellularcarcinomaconqueredbyalppsacasereport AT nirjharraj largehepatocellularcarcinomaconqueredbyalppsacasereport AT kamalkishorebishnoi largehepatocellularcarcinomaconqueredbyalppsacasereport |