title: Associating liver partition and portal vein ligation for a patient with hepatocellular carcinoma with a background of hepatitis B related fibrotic liver.
abstract: BACKGROUND
  Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been developed for patients with predicted insufficient future liver remnant volumes to induce more rapid hepatic hypertrophy and increase resectability. In the medical literature, the use of ALPPS in hepatocellular carcinoma (HCC) has rarely been reported.
  
  
  METHODS
  We reported the use of ALPPS in a patient with primarily unresectable HCC arising from a background of hepatitis B related liver fibrosis. Preoperative computed tomography (CT) showed 2 large conglomerated tumors measuring 16cm×10.5cm in liver segments 5, 6, 7 and 8, and at least 3 satellite nodules with the largest one measuring 3cm around the main tumor and another 4cm tumor in segment 4. Right trisectionectomy after ALPPS was successfully performed. He was discharged from hospital on postoperative day 13 after the second operation. Follow-up CT scan at 6 weeks after the second operation showed further hypertrophy of the liver remnant and no liver recurrence.
  
  
  CONCLUSIONS
  Our case showed that this novel strategy is feasible even in the context of a background of chronic hepatitis B related liver fibrosis, although the hypertrophy rate was a little bit slower and the time needed was longer.
  
  
  CONCLUSIONS
  ALPPS is also feasible in liver fibrosis. It gives hope to patients with HCC who previously were considered as having unresectable diseases. More studies are needed to further evaluate the effectiveness and oncological outcomes of ALPPS from these patients.
authors.affiliation: Department of Surgery, Queen Elizabeth Hospital, Hong Kong SAR, China.
authors.forename: Nam Hung
authors.initials: NH
authors.lastname: Chia
authors.affiliation: Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
authors.forename: Eric C H
authors.initials: EC
authors.lastname: Lai
authors.affiliation: Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China. Electronic address: josephlau@cuhk.edu.hk.
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
keywords: ALPPS; Future liver remnant; Hepatitis B; Hepatocellular carcinoma; PPVE; Trisectionectomy