The combination of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), interventional hepatoma therapy, targeted therapy, and immunotherapy: a case series of a novel AITI conversion therapy model.

Background: Conversion therapy has been a hot field of hepatocellular carcinoma (HCC). The combination of interventional hepatoma therapy, targeted therapy and immunotherapy is an emerging conversion therapy, but its conversion efficiency has not been demonstrated. Its emergence limited the use of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). The way of turning unresectable tumors into resectable tumors is being explored. We integrated the ALPPS, interventional hepatoma therapy, targeted therapy, immunotherapy and proposed a novel conversion therapy named AITI. Case Description: Patients treated with the AITI conversion therapy model in The First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. ALPPS was selected for patients who, after physician evaluation, were considered potentially resectable but had insufficient future liver remnant (FLR). Interventional hepatoma therapy, targeted therapy, and immunotherapy were used before first-stage ALPPS or between stages. Five patients received AITI conversion therapy model. Three patients underwent traditional conversion therapy between the two stages of the ALPPS and achieved satisfactory hypertrophy, while two patients achieved radical resection through ALPPS following conversion therapy. Among all patients, the mean residual volume before the first-stage surgery was 580±245 mL, and increased to 701±295 mL before the second-stage surgery. The mean duration of the first-stage surgery was 175.00±17.32 minutes with a blood loss of 210.00±124.50 mL. For the second-stage surgery, the mean duration was 234.00±25.35 minutes with a blood loss of 400.00±70.71 mL. The average duration of treatment was 136.8±98.3 days. Conclusions: The AITI conversion therapy model is safe and affective. This approach can provide more opportunities for unresectable patients to achieve radical resection.