Associating liver partition and portal vein ligation for a patient with hepatocellular carcinoma with a background of hepatitis B related fibrotic liver

• Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has rarely been reported for patients with hepatocellular carcinoma (HCC).
• ALPPS is feasible even in the context of HCC with a background of chronic hepatitis B related liver fibrosis.
• The hypertrophy rate of the liver remnant was slower and the time needed between the two stages of the operation was longer.

INTRODUCTIONAssociating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been developed for patients with predicted insufficient future liver remnant volumes to induce more rapid hepatic hypertrophy and increase resectability. In the medical literature, the use of ALPPS in hepatocellular carcinoma (HCC) has rarely been reported.PRESENTATION OF CASEWe reported the use of ALPPS in a patient with primarily unresectable HCC arising from a background of hepatitis B related liver fibrosis. Preoperative computed tomography (CT) showed 2 large conglomerated tumors measuring 16 cm × 10.5 cm in liver segments 5, 6, 7 and 8, and at least 3 satellite nodules with the largest one measuring 3 cm around the main tumor and another 4 cm tumor in segment 4. Right trisectionectomy after ALPPS was successfully performed. He was discharged from hospital on postoperative day 13 after the second operation. Follow-up CT scan at 6 weeks after the second operation showed further hypertrophy of the liver remnant and no liver recurrence.DISCUSSIONOur case showed that this novel strategy is feasible even in the context of a background of chronic hepatitis B related liver fibrosis, although the hypertrophy rate was a little bit slower and the time needed was longer.CONCLUSIONALPPS is also feasible in liver fibrosis. It gives hope to patients with HCC who previously were considered as having unresectable diseases. More studies are needed to further evaluate the effectiveness and oncological outcomes of ALPPS from these patients.