Table 2. Intraoperative and postoperative data of patients in the two groups.
| Index | Findings | P value | |
|---|---|---|---|
| ALPPS group | TACE + PVE group | ||
| Data on first operation | |||
| First operation/procedure | ALPPS stage-1 (n=38, 100%), Rt PVL (n=32, 84.2%), Lt PVL (n=6, 15.8%) | TACE (n=38, 100%), PVE (n=38, 100%), Rt PVE (n=28, 73.7%), Rt+ segment 4 PVE (n=8, 21.1%), Lt+ segment 5 8 PVE (n=2, 5.3%) | |
| Intraoperative findings, median (range) | |||
| Operating time (min) | 147.5 (55.0–255) | 140 (100.0–175) | 0.274 |
| Pringle’s maneuver (min) | 15 (0–22.0) | 0 | |
| Intraoperative blood loss (mL) | 200 (100.0–800) | 0 | |
| Intraoperative blood transfusion (units) | 0 (0–4.0) | 0 | |
| Postoperative complications* (Clavien Dindo) | |||
| ≥ Grade IIIa | n=6, 15.8%* | (n=1, 2.6%) | 0.108 |
| Grade III | Ascites (n=1, 2.6%), pleural effusion (n=1, 2.6%), biliary obstruction (n=1, 2.6%), bile leakage (n=1, 2.6%), abdominal infection (n=2, 5.3%) | ||
| Grade IV | n=0 | Liver failure (n=1, 2.6%) | 1.000 |
| Data on second operation | |||
| Second operation | ALPPS stage-2 (n=37, 97.4%) | Stage-2 hepatectomy (n=25, 65.8%) | <0.001 |
| Reasons for not proceeding to stage-2 hepatectomy | Total: n=1 (2.6%), insufficient hypertrophy of FLR (n=1, 2.6%) | Total: n=13 (34.2%), tumor progression (n=5, 13.2%), insufficient hypertrophy of FLR (n=6, 15.8%), deranged LF (n=1, 2.6%), refused operation because of tumor necrosis (n=1, 2.6%) | |
| Second operation time, min | 145 (105.0–380) | 210 (140.0–270) | <0.001 |
| Intraoperative data | |||
| Pringle maneuver duration, min | 12 (0–22.0) | 21 (0–47.0) | <0.001 |
| Number of blood transfusion, n (%) | 18/37 (48.6%) | 14/25 (56.0%) | 0.570 |
| Intraoperative bleeding volume, mL | 400 (100.0–4,700) | 800 (150.0–4,400) | 0.280 |
| Type of hepatectomy | |||
| Right hepatectomy | 22 (59.5%) | 17 (68.0%) | |
| Left hepatectomy | 2 (5.4%) | 0 | |
| Right trisectionectomy | 9 (24.3%) | 6 (24.0%) | |
| Left trisectionectomy | 4 (10.8%) | 2 (8.0) | |
| Complications, n (%) | 35/37 (94.6%) | 22/25 (88%) | 0.385 |
| Major complications (≥ IIIa)† | 20/37 (54.1%) | 5/25 (20%) | 0.007 |
| Grade III | n=18, 48.6% | n=4, 16.0% | |
| Bile leakage ± ascites ± pleural effusion | 11 (29.7%) | 1 (4.0%) | |
| Atelectasis + intra-abdominal infection | 1 (2.7%) | 0 | |
| Pleural effusion + hemorrhage | 2 (5.4%) | 0 | |
| Pleural effusion + disruption of wound | 1 (2.7%) | 0 | |
| Pleural effusion | 1 (2.7%) | 2 (8.0%) | |
| Hemorrhage | 0 | 1 (4.0%) | |
| Ascites | 1 (2.7%) | 0 | |
| Bile leakage | 1 (2.7%) | 0 | |
| Grade IV | n=2, 5.4% | n=1, 4.0% | |
| Liver failure | 2 (5.4%) | 1 (4.0%) | |
| Resection margin (cm) | 1 (0.5–2.0) | 1 (0.5–2.2) | 0.602 |
| Postoperative liver failure, n (%) | 13/37 (35.1%) | 6/25 (24.0%) | 0.351 |
| Grade A | 5 | 3 | |
| Grade B | 5 | 2 | |
| Grade C | 3 | 1 | |
| Death in 90 days, n (%) | 2/38 (5.3%) | 2/38 (5.3%) | 1.000 |
| Cause of death: liver failure | 2 | 2 | |
| HCC recurrence on follow-up | 19/37 (51.4%) | 13/25 (52.0%) | |
| Treatment of recurrence | |||
| Rehepatectomy | 1 (2.7%) | 1 (4.0%) | |
| TACE | 2 (5.4%) | 5 (20.0%) | |
| TACE + sorafenib | 5 (13.5%) | 0 | |
| PMCT | 2 (5.4%) | 1 (4.0%) | |
| PMCT + TACE | 0 | 1 (4.0%) | |
| PMCT + radiotherapy | 2 (5.4%) | 0 | |
| External radiation | 2 (5.4%) | 0 | |
| Sorafenib | 3 (8.1%) | 3 (12.0%) | |
| Supportive treatment | 2 (5.4%) | 2 (8.0%) | |
*, all complications responded to drainage and conservative treatment; †, all complications were coped with conservative treatment, drainage or reoperation. PVL, portal vein ligation; deranged LF, deranged liver function; Lt, left portal trunk; Rt, right portal trunk; PMCT, percutaneous microwave coagulation therapy.