Rescue radiofrequency ablation or percutaneous ethanol injection: a strategy for failed RALPPS stage-1 in patients with cirrhosis-related hepatocellular carcinoma

• Published in: BMC surgery 2021-05, Vol.21 (1), p.246-246, Article 246
• Main Authors: Wang, Qiang, Chen, Shu, Yan, Jun, Brismar, Torkel, Sparrelid, Ernesto, Qu, Chengming, Ji, Yujun, Chen, Shihan, Ma, Kuansheng
• Format: Article
• Language: English
• Subjects: Abdomen; Ablation; Ablation (Surgery); Acetaldehyde; Alcohol; Alcohol, Denatured; Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS); Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - surgery; Care and treatment; Catheter Ablation; Cirrhosis; Complications; Ethanol; Future liver remnant (FLR); Growth rate; Hepatectomy; Hepatitis; Hepatocellular carcinoma; Hepatocellular carcinoma (HCC); Hepatoma; Hospitals; Humans; Injection; Ligation; Liver; Liver cancer; Liver cirrhosis; Liver Cirrhosis - complications; Liver Neoplasms - complications; Liver Neoplasms - surgery; Lobes; Medicin och hälsovetenskap; Metastases; Metastasis; Mortality; Percutaneous ethanol injection (PEI); Portal vein; Portal Vein - surgery; Radio frequency; Radiofrequency Ablation; Radiofrequency ablation (RFA); Statistical analysis; Strategy; Surgical techniques; Tumors; Ultrasonic imaging; Veins & arteries
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-021-01241-z

The future liver remnant (FLR) faces a risk of poor growth in patients with cirrhosis-related hepatocellular carcinoma (HCC) after stage-1 radiofrequency-assisted ALPPS (RALPPS). The present study presents a strategy to trigger further FLR growth using supplementary radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI). At RALPPS stage-1 the portal vein branch was ligated, followed by intraoperative RFA creating a coagulated avascular area between the FLR and the deportalized lobes. During the interstage period, patients not achieving sufficient liver size (≥ 40%) within 2-3 weeks underwent additional percutaneous RFA/PEI of the deportalized lobes (rescue RFA/PEI) in an attempt to further stimulate FLR growth. Seven patients underwent rescue RFA/PEI after RALPPS stage-1. In total five RFAs and eight PEIs were applied in these patients. The kinetic growth rate (KGR) was highest the first week after RALPPS stage-1 (10%, range - 1% to 15%), and then dropped to 1.5% (0-9%) in the second week (p