ĐÁNH GIÁ KẾT QUẢ PHẪU THUẬT ALPPS - CẮT GAN 2 THÌ ĐIỀU TRỊ UNG THƯ BIỂU MÔ TẾ BÀO GAN

Abstract

Background: Hepatocellular carcinoma (HCC) is highly prevalent in Vietnam. In patients with insufficient future liver remnant (FLR), portal vein embolization (PVE) may be ineffective or contraindicated. Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has emerged as a strategy to induce rapid hypertrophy and enable curative resection in otherwise unresectable cases. Methods: We conducted a prospective cohort study of HCC patients undergoing ALPPS at the University Medical Center Ho Chi Minh City (May 2018–June 2025). Eligible patients required right or extended right hepatectomy with inadequate FLR and were not candidates for percutaneous PVE. Results: Sixty patients were included (mean age 53 years; male-to-female ratio 5.5:1; all Child–Pugh A). Median tumor size was 8.5 cm; 50% had right portal vein thrombosis. Tumor stage was BCLC A (5.1%), B (37.3%), and C (57.6%). Laparoscopic stage 1 was performed in 82%. Median interstage interval was 24 days. Mean FLR increased from 326 to 528 ml (+70%). Major hepatectomy was completed in 85%. Stage 2 morbidity occurred in 19.6% (ascites, infection, bile leak, pneumonia), with one postoperative death (1.6%). Disease-free survival at 3, 6, and 12 months was 92%, 65%, and 45%, respectively; overall survival was 86%, 82%, and 82%. Conclusions: ALPPS achieved substantial FLR hypertrophy and enabled resection in the majority of HCC patients otherwise ineligible for surgery. Early morbidity and mortality were acceptable, and short-term oncologic outcomes were encouraging. Larger studies are warranted to confirm the role of ALPPS in advanced HCC.