Application of portal vein chemoembolization in major hepatectomy for initially unresectable primary and secondary hepatic tumors

Abstract

To investigate the surgical treatment of initially unresectable primary and secondary hepatic tumors. For the patients with multiple and bilobar colonic hepatic metastases, a first-stage hepatectomy consisted in a radical resection of sigmoid colonic carcinoma and left lateral hepatic segment. Subsequently, under the guidance of ultrasonography and radiography, a right portal vein chemoembolization (PVCE) was performed via a percutaneous approach through left portal branch to induce the atrophy of right hemiliver and hypertrophy of left hemiliver. At Week 5 post-PVCE, a second-stage hepatectomy was planned to resect the right hemiliver. For patients with huge hepatocellular carcinoma (HCC), transcatheter arterial chemoembolization (TACE) were performed and it was followed by PVCE 1 week later. At Week 4 post-PVCE, a right trisegmentectomy was attempted to resect the right liver tumor. The volume of liver was evaluated with three-dimensional CT scan at Weeks 2 and 4 weeks post-PVCE. At Week 4 post-PVCE, the atrophy of right lobe was induced and the left lobe underwent compensatory hypertrophy. The remnant volumes of right lobe and right trisegmentectomy for HCC decreased from 1380.0 cm(3), 1685.4 cm(3) at pre-PVCE to 740.2 cm(3), 1228.1 cm(3) at post-PVCE. The values increased from pre-PVCE 435.1 cm(3), 151.5 cm(3) to post-PVCE 624.4 cm(3), 560.2 cm(3) for left hepatic lobe remnant of colonic liver metastases and left lateral segment for HCC. The ratios of liver remnant to estimated total liver volume increased from 25.6%, 13.6% at pre-PVCE to 50.0%, 43.1% post-PVCE respectively. The postoperative course was uneventful. The liver function, serum CEA and AFP decreased to the normal levels. Two patients were followed up for 18 and 8 months respectively. There was no tumor recurrence. PVCE prevents the hepatic function failure after a major hepatectomy. And it may benefit more patients with previously unresectable liver tumors.