PMC9902497_01
Graphic summary of the case. (A) CT scans obtained before stage I ALPPS (a), after stage I ALPPS (b), during TACE (c), after TACE (d), after stage II ALPPS (e), and showing lung metastasis during follow-up (f). (B) The change of estimated future liver remnant (FLR). CT, computed tomography; ALPPS, associated liver partition and portal vein ligation for staged hepatectomy; TACE, transhepatic arterial chemoembolization; FLR, future liver remnant.
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F1
The estimated preoperative standard liver volume (SLV) was 1386.16 ml, and the evaluated FLR was 300 ml based on CT assessment (Figure 1).
Hepatic angiography and TACE were performed to block the main arterial supply to the tumor. (A) The arterial phase of the CT scan before TACE. (B) The CT vascular reconstruction before TACE. (C) The main arterial blood supply to the tumor and significant tumor staining before TACE. (D) The main artery supplying the tumor was blocked using super-selective TACE, and the tumor staining disappeared. TACE, transhepatic arterial chemoembolization; CT, computed tomography.
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F2
After chemoembolization, the arterial flow to the large tumor almost completely disappeared (Figure 2).
Representative images of the resected tumor and histopathological examination. (A) Representative image of the resected tumor. (B-D) Representative images show the results of histopathological examination. (B) 100x magnification. (C) 200x magnification. (D) 400x magnification.
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F3
Histopathology confirmed a 12 cm x 9 cm x 14 cm HCC in the resected liver (Figure 3).