Comparison of clinical efficacy between LAPS and ALPPS in the treatment of hepatitis B virus-related hepatocellular carcinoma

Laparoscopic associating liver partition and portal vein ligation for staged hepatectomy for colorectal liver metastases: A single-center experience

BACKGROUND

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a procedure used for patients with initially unresectable colorectal liver metastases (CRLM). However, the procedure has been reported to be associated with high morbidity and mortality. Laparoscopic ALPPS has recently been reported as a minimally invasive technique that reduces perioperative risks.

AIM

To assess the safety and feasibility of full laparoscopic ALPPS in patients with CRLM.

METHODS

A retrospective analysis was conducted on all consecutive patients with CRLM who underwent full laparoscopic ALPPS at the Sixth Affiliated Hospital of Sun Yat-sen University between March 2021 and July 2024.

RESULTS

Fifteen patients were included, 13 with synchronous liver metastases. Nine patients had more than five liver tumors, with the highest count being 22. The median diameter of the largest lesion was 2.8 cm on preoperative imaging. No extrahepatic metastases were observed. RAS mutations were detected in nine patients, and 14 underwent preoperative chemotherapy. The median increase in future liver remnant volume during the interstage interval was 47.0%. All patients underwent R0 resection. Overall complication rates were 13.3% (stage 1) and 53.3% (stage 2), while major complication rates (Clavien-Dindo ≥ IIIa) were 13.3% (stage 1) and 33.3% (stage 2). No mortality occurred in either stage. The median hospital stay after stage 2 was 10 days.

CONCLUSION

Full laparoscopic ALPPS for CRLM is safe and feasible, with the potential for reduced morbidity and mortality, offering radical resection opportunities for patients with initially unresectable CRLM.

Current advances and future directions in combined hepatocellular and cholangiocarcinoma

The low incidence of combined hepatocellular cholangiocarcinoma (cHCC-CCA) is an important factor limiting research progression. Our study extensively included nearly three decades of relevant literature and assembled the most comprehensive database comprising 5,742 patients with cHCC-CCA. We summarized the characteristics, tumor markers, and clinical features of these patients. Additionally, we present the evolution of cHCC-CCA classification and explain the underlying rationale for these classification standards. We reviewed cHCC-CCA diagnostic advances using imaging features, tumor markers, and postoperative pathology, as well as treatment options such as surgical, adjuvant, and immune-targeted therapies. In addition, recent advances in more effective chemotherapeutic regimens and immune-targeted therapies were explored. Furthermore, we described the molecular mutation features and potential specific markers of cHCC-CCA. The prognostic value of Nestin has been proven, and we speculate that Nestin will also play a role in classification and diagnosis. However, further research is needed. Moreover, we believe that the possibility of using machine learning liquid biopsy for preoperative diagnosis and establishing a scoring system are directions for future research.