Application of transcatheter arterial chemoembolization combined with selective portal vein embolization in two-stage hepatectomy of hepatocellular carcinoma

Abstract

Objective To explore the application of transcatheter arterial chemoembolization （TACE） combined with selective portal vein embolization （SPVE ） in two-stage hepatectomy of hepatocellular carcinoma （HCC）.Methods From September 2010 to September 2013,a total of 107 patients with HCC in the right liver lobe who were not suitable for one stage hepatectomy received TACE or TACE combined with SPVE treatment were enrolled.Among them,55 received TACE therapy and 52 accepted TACE combined with SPVE treatment.The technique success rate,complication,adverse reactions,the volume change of each liver lobe and the rate of hepatectomy of HCC were observed.Chi-square test was used for numerical data comparison and Student′s t test for measurement data.Results TACE or TACE combined with SPVE therapy was successfully applied in all the 107 patients,the technique success rate was 100%.During treatment period,no complications such as ectopic embolization, liver function failure,puncture tract bleeding,gastrointestinal bleeding,bile leakage and hepatic abscess were observed.After treatment,the adverse reactions included liver function impairment,pain in hepatic region,fever,nausea and vomiting.Four weeks after the treatment,the volumes of tumor and right liver lobe decreased to certain degree in patients with HCC of both TACE group and TACE combined with SPVE group.The volume of left liver lobe in TACE group had no obvious change,while remarkably increased in TACE combined with SPVE group.The pre-treatment residual liver volume （RLV）of TACE group and TACE combined with SPVE group was （404.0 ± 46.3 ）cm^3 and （393.9 ± 65 .7 ）cm^3 , respectively,and the difference was not statistically significant （t=0.927,P =0.356）.Four weeks after the treatment,RLV was （415.4 ±45.7 ）cm^3 and （567.3 ±88.7 ）cm^3 ,respectively,and the difference was statistically significant （t= -11 .219,P 〈0.05）.Patients were followed up for three to six months,the rates of hepatectomy were 38.2%（21/55）and 86.5 %（45/52）in TACE group and TACE combined with SPVE group,and the difference was statistically significant （χ^2 =26.440,P 〈0.01 ）.Conclusion For patients with HCC not suitable for one stage hepatectomy,the treatment of TACE combined with SPVE before operation could effectively control the growth of the tumor,decrease the volume of tumor,increase RLV,and then increase the rate of two-stage hepatectomy. Key words: Liver neoplasms; Interventional; Embolization; Portal vein; Two-stage hepatectomy