残肝体积不足的肝恶性肿瘤患者转化治疗的研究进展

摘要/Abstract

摘要： 对于肝脏原发或局限性转移的恶性肿瘤患者,获得长期生存的唯一机会是完全切除肝脏肿瘤。但肝切除术后肝衰竭（PHLF）仍然是肝切除术后主要死亡原因,而残余肝体积不足已经被证明是PHLF的主要危险因素。目前已有多种方法来进行术前转化治疗,门静脉栓塞和联合肝脏离断和门静脉结扎的二步肝切除术是目前应用最多的两种方法,但各自都有明显的优缺点。随着恶性肿瘤综合治疗的发展,多种治疗方法正在探索中,本研究对比了不同的转化治疗方法,旨在为临床提供参考。

关键词: 肝恶性肿瘤, 残余肝体积, 转化治疗

Abstract: For patients with primary or locally metastatic malignant liver tumors,the only chance for long-term survival is complete resection of the liver tumors. However, post-hepatectomy liver failure(PHLF) remains a major cause of mortality after liver resection,and inadequate future liver remnant has been proven to be a major risk factor for PHLF. Currently,various methods exist for preoperative conversion therapy. Portal vein embolization and associating liver partition and portal vein ligation for staged hepatectomy are the two most widely used methods. However, each method has its distinct advantages and disadvantages. With the development of comprehensive treatment for malignant tumors, several treatment methods are under exploration. This study compares different conversion therapy methods,aiming to provide clinical references.

Key words: Malignant liver tumors, Future liver remnant, Conversion therapy

李新, 李智宇. 残肝体积不足的肝恶性肿瘤患者转化治疗的研究进展[J]. 肝癌电子杂志, 2024, 11(1): 16-20.

Li Xin, Li Zhiyu. Research progress on conversion therapy for patients with malignant liver tumors with inadequate remnant liver volume[J]. Electronic Journal of Liver Tumor, 2024, 11(1): 16-20.

参考文献

[1] SCHNITZBAUER A A, LANG S A, GOESSMANN H, et al.Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings[J]. Ann Surg, 2012, 255(3): 405-414.
[2] RAHNEMAI-AZAR A A, CLOYD J M, WEBER S M, et al. Update on liver failure following hepatic resection: strategies for prediction and avoidance of post-operative liver insufficiency[J]. J Clin Transl Hepatol, 2018, 6(1): 97-104.
[3] HOBEIKA C, GUYARD C, SARTORIS R, et al.Performance of non-invasive biomarkers compared with invasive methods for risk prediction of posthepatectomy liver failure in hepatocellular carcinoma[J]. Br J Surg, 2022, 109(5): 455-463.
[4] 中华人民共和国国家卫生健康委员会. 原发性肝癌诊疗指南(2022年版)[J/CD]. 肿瘤综合治疗电子杂志,2022,8(2):16-53.
[5] KIM D, CORNMAN-HOMONOFF J, MADOFF D C.Preparing for liver surgery with "Alphabet Soup": PVE, ALPPS, TAE-PVE, LVD and RL[J]. Hepatobiliary Surg Nutr, 2020, 9(2): 136-151.
[6] MAKUUCHI M, THAI B L, TAKAYASU K, et al.Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report[J]. Surgery, 1990, 107(5): 521-527.
[7] CASSESE G, HAN H S, LEE B, et al.Portal vein embolization failure: current strategies and future perspectives to improve liver hypertrophy before major oncological liver resection[J]. World J Gastrointest Oncol, 2022, 14(11): 2088-2096.
[8] CHARLES J, NEZAMI N, LOYA M, et al.Portal vein embolization: rationale, techniques, and outcomes to maximize remnant liver hypertrophy with a focus on contemporary strategies[J]. Life (Basel), 2023, 13(2): 279.
[9] CHANSANGRAT J, KEERATIBHARAT N. Portal vein embolization: rationale, techniques, outcomes and novel strategies[J]. Hepat Oncol, 2021, 8(4): HEP42.
[10] HUANG Y, GE W, KONG Y, et al.Preoperative portal vein embolization for liver resection: an updated Meta-analysis[J]. J Cancer, 2021, 12(6): 1770-1778.
[11] GIGLIO M C, GIAKOUSTIDIS A, DRAZ A, et al.Oncological outcomes of major liver resection following portal vein embolization: a systematic review and Meta-analysis[J]. Ann Surg Oncol, 2016, 23(11): 3709-3717.
[12] DEL BASSO C, GAILLARD M, LAINAS P, et al.Current strategies to induce liver remnant hypertrophy before major liver resection[J]. World J Hepatol, 2021, 13(11): 1629-1641.
[13] HWANG S, LEE S G, KO G Y, et al.Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy[J]. Ann Surg, 2009, 249(4): 608-616.
[14] DESHAYES E, PIRON L, BOUVIER A, et al.Study protocol of the HYPER-LIV01 trial: a multicenter phaseⅡ, prospective and randomized study comparing simultaneous portal and hepatic vein embolization to portal vein embolization for hypertrophy of the future liver remnant before major hepatectomy for colo-rectal liver metastases[J]. BMC Cancer, 2020, 20(1): 574.
[15] SCHADDE E, GUIU B, DEAL R, et al.Simultaneous hepatic and portal vein ligation induces rapid liver hypertrophy:A study in pigs[J]. Surgery, 2019, 165(3): 525-533
[16] GUIU B, QUENET F, PANARO F, et al.Liver venous deprivation versus portal vein embolization before major hepatectomy: future liver remnant volumetric and functional changes[J]. Hepatobiliary Surg Nutr, 2020, 9(5): 564-576.
[17] MARINO R, RATTI F, DELLA CORTE A, et al.Comparing liver venous deprivation and portal vein embolization for perihilar cholangiocarcinoma:is it time to shift the focus to hepatic functional reserve rather than hypertrophy[J]? Cancers (Basel), 2023, 15(17): 4363.
[18] LANG H, DE SANTIBAÑES E, SCHLITT H J, et al. 10th anniversary of ALPPS-lessons learned and quo vadis[J]. Ann Surg, 2019, 269(1): 114-119.
[19] SCHADDE E, ARDILES V, ROBLES-CAMPOS R, et al.ALPPS registry group. Early survival and safety of ALPPS: first report of the international ALPPS registry[J]. Ann Surg, 2014, 260(5): 829-836.
[20] SCHADDE E, RAPTIS D A,SCHNITZBAUER A A, et al.Prediction of mortality after ALPPS stage-1: an analysis of 320 patients from the international ALPPS registry[J]. Ann Surg, 2015, 262(5): 780-785.
[21] SANDSTRÖM P, RØSOK B I, SPARRELID E, et al. ALPPS improves resectability compared with conventional two-stage hepatectomy in patients with advanced colorectal liver metastasis: results from a scandinavian multicenter randomized controlled trial(LIGRO Trial)[J]. Ann Surg, 2018, 267(5): 833-840.
[22] BELL R, BEGUM S, PRASAD R, et al.Volume and flow modulation strategies to mitigate post-hepatectomy liver failure[J]. Front Oncol, 2022, 12: 1021018.
[23] DE SANTIBAÑES E, CLAVIEN P A. Playing Play-Doh to prevent postoperative liver failure: the "ALPPS" approach[J]. Ann Surg, 2012, 255(3): 415-417.
[24] LODGE J P.ALPPS: the argument for[J]. Eur J Surg Oncol, 2017, 43(2): 246-248.
[25] LI P P, HUANG G, JIA N Y, et al.Associating liver partition and portal vein ligation for staged hepatectomy versus sequential transarterial chemoembolization and portal vein embolization in staged hepatectomy for HBV-related hepatocellular carcinoma: a randomized comparative study[J]. Hepatobiliary Surg Nutr, 2022, 11(1): 38-51.
[26] LUNARDI A, CERVELLI R, VOLTERRANI D, et al.Feasibility of percutaneous intrahepatic split by microwave ablation (PISA) after portal vein embolization for hypertrophy of future liver remnant: the radiological stage-1 ALPPS[J]. Cardiovasc Intervent Radiol, 2018, 41(5): 789-798.
[27] TERASAWA M, ALLARD M A, GOLSE N, et al.Sequential transcatheter arterial chemoembolization and portal vein embolization versus portal vein embolization alone before major hepatectomy for patients with large hepatocellular carcinoma: an intent-to-treat analysis[J]. Surgery, 2020, 167(2): 425-431.
[28] ZHANG C W, DOU C W, ZHANG X L, et al.Simultaneous transcatheter arterial chemoembolization and portal vein embolization for patients with large hepatocellular carcinoma before major hepatectomy[J]. World J Gastroenterol, 2020, 26(30): 4489-4500.
[29] PARK G C, LEE S G, YOON Y I, et al.Sequential transcatheter arterial chemoembolization and portal vein embolization before right hemihepatectomy in patients with hepatocellular carcinoma[J]. Hepatobiliary Pancreat Dis Int, 2020, 19(3): 244-251.
[30] SHAO Z, LIU X, PENG C, et al.Combination of transcatheter arterial chemoembolization and portal vein embolization for patients with hepatocellular carcinoma: a review[J]. World J Surg Oncol, 2021, 19(1): 293.
[31] WU M, ZHANG L, SHI K, et al.Polydopamine-coated radiolabeled microspheres for combinatorial radioembolization and photothermal cancer therapy[J]. ACS Appl Mater Interfaces, 2023, 15(10): 12669-12677.
[32] JAKOBS T F, SALEEM S, ATASSI B, et al.Fibrosis, portal hypertension, and hepatic volume changes induced by intra-arterial radiotherapy with 90yttrium microspheres[J]. Dig Dis Sci, 2008, 53(9): 2556-2563
[33] MALHOTRA A, LIU D M, TALENFELD A D.Radiation segmentectomy and radiation lobectomy: a practical review of techniques[J]. Tech Vasc Interv Radiol, 2019, 22(2): 49-57
[34] VOUCHE M, LEWANDOWSKI R J, ATASSI R, et al.Radiation lobectomy: time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection[J]. J Hepatol, 2013, 59(5): 1029-1036.
[35] GARLIPP B, DE BAERE T, DAMM R, et al.Left-liver hypertrophy after therapeutic right-liver radioembolization is substantial but less than after portal vein embolization[J]. Hepatology, 2014, 59(5): 1864-1873.
[36] PALARD X, EDELINE J, ROLLAND Y, et al.Dosimetric parameters predicting contralateral liver hypertrophy after unilobar radioembolization of hepatocellular carcinoma[J]. Eur J Nucl Med Mol Imaging, 2018, 45(3): 392-401.
[37] BOUAZZA F, PONCELET A, GARCIA C A, et al.Radioembolisation and portal vein embolization before resection of large hepatocellular carcinoma[J]. World J Gastroenterol, 2015, 21(32): 9666-9670.
[38] LEE H S, CHOI G H, CHOI J S, et al.Surgical resection after down-staging of locally advanced hepatocellular carcinoma by localized concurrent chemoradiotherapy[J]. Ann Surg Oncol, 2014, 21(11): 3646-3653
[39] SUN H C, ZHOU J, WANG Z, et al.Alliance of Liver Cancer Conversion Therapy, Committee of Liver Cancer of the Chinese Anti-Cancer Association. Chinese expert consensus on conversion therapy for hepatocellular carcinoma (2021 edition)[J]. Hepatobiliary Surg Nutr, 2022, 11(2): 227-252.
[40] RIM C H, PARK S, WOO J Y, et al.Compensatory hypertrophy of the liver after external beam radiotherapy for primary liver cancer[J]. Strahlenther Onkol, 2018, 194(11): 1017-1029.
[41] LIN Q, CHEN D, LI K, et al.Case report: massive hepatocellular carcinoma complete surgical resection after portal vein embolization and multimodality therapy[J]. Front Radiol, 2022, 2: 858963.
[42] BEPPU T, NITTA H, HAYASHI H, et al.Effect of branched-chain amino acid supplementation on functional liver regeneration in patients undergoing portal vein embolization and sequential hepatectomy: a randomized controlled trial[J]. J Gastroenterol, 2015, 50(12): 1197-1205.
[43] AM ESCH J S, SCHMELZLE M, FÜRST G, et al. Infusion of CD133+ bone marrow-derived stem cells after selective portal vein embolization enhances functional hepatic reserves after extended right hepatectomy: a retrospective single-center study[J]. Ann Surg, 2012, 255(1): 79-85.