Associating liver partition and portal vein ligation for staged hepatectomy in patients with hepatocellular carcinoma: laparoscopic versus open approach and its impact on future remnant hypertrophy.

[BACKGROUND] There is a scarcity of data on the feasibility of laparoscopic approach to associating liver partition and portal vein ligation for staged hepatectomy (Lap-ALPPS) regarding its impact on functional liver remnant (FLR) hypertrophy when compared with the open approach.

[METHODS] A retrospective study of patients who underwent open or lap-ALPPS for hepatocellular carcinoma (HCC) in a tertiary referral centre in Hong Kong during the period from December 2013 to April 2023.

[RESULTS] Fifty-seven (42 open and 15 laparoscopic) ALPPS were performed for HCC. The open group had more blood loss during stage I (500 ml vs. 300 ml, p = 0.001). The morbidity (Clavien-Dindo grade ≥ 3a) (14.3 % vs. 26.7 %, p = 0.43) and Grade B/C post-hepatectomy liver failure rates (20.0 % vs 35.7 %, p = 0.34) were similar. The open group had a higher percentage increment in remnant volume (50.6 % vs. 34.8 %, p = 0.02). Linear regression revealed that a small pre-operative FLR/ESLV (B = -1.75, 95 % CI -2.82-0.678, p < 0.001) and an open approach at stage I B = -20.2, 95 % CI -37.7-2.68, p < 0.001) predicted a higher percentage increment in remnant volume.

[CONCLUSION] Lap-ALPPS had less blood loss but was associated with slower hypertrophy. Hence, a longer waiting time to stage II ALPPS may be required in selected patients.