ALPPS versus PVE in Hepatitis-related Hepatocellular Carcinoma-Comparison of Oncological Outcomes

Introduction: ALPPS has been popularised for future liver remnant (FLR) augmentation in liver metastasis or noncirrhotic liver tumors in recent years. Data on the oncological outcomes of ALPPS in chronic hepatitis or cirrhosis related HCC remained limited. Methods: Consecutive patients received hepatectomy after future liver remnant (FLR) modulation by either ALPPS or PVE were recruited. Inclusion criteria were hepatitis B or C carrier, pathologically confirmed HCC and successful flow modulation. Data for clinicopathological details and oncological outcome were reviewed for ALPPS and compared with portal vein embolization (PVE). Results: From 2002 to 2019, 126 patients with HCC underwent FLR modulation (54 ALPPS and 72 PVE) followed by hepatectomy. Hepatitis B surface antigenicity was positive in 112 patients. ALPPS induced absolute FLR volume increment by 47.1%, or FLR estimated total liver volume by 11.7% in 6 days. No difference in morbidity (19.6% vs 31.4%, P=0.2) and mortality (5.6% vs 5.8%, P =1.000) with PVE was observed. Five-year overall survival for ALPPS and PVE was 52.8% and 61.8% (P =0.663). The overall HCC recurrence rate was 50% and there was no significant difference between two groups (48.1% vs 51.4%, P=0.86). Presence of vascular invasion (P=0.038 OR 1.6 95%CI 1.03-2.74) and post-operative complication (P=0.008 OR 1.95 95%CI 1.19-3.2) were the two independent factors associated with post-hepatectomy HCC recurrence. Conclusion: No significant difference in HCC recurrence between two FLR modulation approach was demonstrated. ALPPS conferred a comparable efficacy and oncological outcomes in comparison to PVE