To evaluate the clinical efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with right hepatic vein ligation in the treatment of massive hepatocellular carcinoma (HCC).

A 38-year-old male patient, weighed 53 kg, was admitted to hospital due to distending pain in the right upper abdomen for over half a month and liver-occupying lesions for 6 d. Contrast-enhanced ultrasound of liver indicated the right lobe-occupying lesion. Preliminary diagnosis: massive HCC of the right lobe with tumor thrombus in right hepatic vein, BCLC stage C, primary liver cancer stage Ⅲa of China and Child-Pugh grade A for liver function. The informed consent of the patient was obtained and the local ethical committee approval was received. The patient underwent the right hepatic vein ligation and ALPPS. In the first stage of operation, the left and right lobes were separated, and the right branch of portal vein and the right hepatic vein were ligated. The right lobe was resected in the second stage.

The operation time of first stage was 414 min. The intraoperative blood loss was 200 ml. No blood transfusion was delivered during the operation. The postoperative complication was mainly ascites, which was relieved after using telipressin combined with oral diuretics. At postoperative 7 d, the volume of the left lobe increased to 530 ml, accounting for 56% of the standard liver volume. At postoperative 18 d, the second-stage operation was performed. The second-stage operation endured for 240 min. The intraoperative blood loss was 500 ml, and 2 U of red blood cells were infused. The complications were classified as Clavien-Dino grade I. The main complication was ascites, which was relieved after liver protection, albumin and diuresis were given. The patient recovered uneventful after operation.

ALPPS combined with the right hepatic vein ligation provides a new reference for the surgery of HCC patients with insufficient residual liver volume complicated with tumor thrombus in the right hepatic vein.