PMC8660853_01
Computed tomography (CT) scans before stage I ALPPS. A giant mass (white arrow) measuring 13.3 x 8.5 x 13.0 cm in liver segments 4, 5, 6, 7, and 8 was showed on CT scans. (A) Plain scan; (B) arterial phase; (C) portal venous phase; (D) venous phase.
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F1
A 56-year-old male with the absence of clinical symptoms was diagnosed as having HCC with a huge tumor (13.3 x 8.5 x 13 cm) in liver segments 4, 5, 6, 7, and 8 (Figures 1A-D).
Computed tomography (CT) scans before stage II ALPPS. Reduce of tumor load (white arrow) and hypertrophy of segments 2 and 3 (asterisk) was showed on CT scans. (A) Plain scan; (B) arterial phase; (C) portal venous phase; (D) venous phase.
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F2
After receiving about 3 months of local therapy, the follow-up imaging (Figures 2A-D) showed that the tumor load was reduced, and the FLR/SLR reached 40% (Figures 3A,B), which meets the requirements of the surgery.
Three-dimensional reconstructions before stage II ALPPS and intraoperative photographs during stage II ALPPS. (A,B) Three-dimensional reconstructions before stage II ALPPS, a large tumor was on the right lobe of liver and most of the liver parenchymal between right and left was divided. (C) hypertrophy of the left lateral segment (asterisk). (D) process to remove the huge tumor (white arrow)- right trisectionectomy.
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F3
After receiving about 3 months of local therapy, the follow-up imaging (Figures 2A-D) showed that the tumor load was reduced, and the FLR/SLR reached 40% (Figures 3A,B), which meets the requirements of the surgery. AFP was 8.06 ng/ml. At initial surgical exploration, hypertrophy of the left lateral segment could be easily observed (Figure 3C). Then, the remaining liver parenchyma close to the first hepatic hilum and in front of the inferior vena cava was continuously separated with an ultrasonic scalpel (Figure 3D).
Surgical specimen and histopathological images. (A) Right trisectionectomy specimen. (B-D) Pathological examination of tissue section. (B) 40X magnification. (C) 100X magnification. (D) 400X magnification.
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F4
T1N0M0, stage IB (AJCC Cancer Staging Manual, 2018) (Figures 4A-D). There was no recurrence at half years of follow-up.