Percutaneous microwave or radiofrequency ablation liver partition and portal vein embolization for planned hepatectomy

Abstract

Objective To explore the clinical outcome of percutaneous microwave/radiofrequency ablation liver partition and portal vein embolization for planned hepatectomy (PAPEP)for the treatment of hepatocelullar carcinoma (HCC) with insufficient future liver remnant (FLR). Methods The retrospective descriptive research method was taken. The clinical data of 2 patients of giant primary HCC (FLR complicated with cirrhosis) who were admitted to the Zhejiang Province People′s Hospital from November 2015 to January 2016 were collected. Treatment plan: ultrasound-guided percutaneous microwave ablation (PMA) or percutaneous radio-frequency ablation (PRA) was performed on patients under intravenous anesthesia, at the same time portal vein embolization (PVE) was conducted. FLR was measured by rescan of computed tomography (CT) at 7-9 days postoperatively, according to FLR hyperplasia and general situation of the patient, right trisegmentectomy and expanded right hemihepatectomy were implemented respectively. Observation indicatiors indicators included (1)standard liver volume (SLV) and FLR before PRA/PVE treatment, (2)liver function, body temperature, FLR and time of FLR hyperplasia after PRA/PVE treatment, (3)liver function, body temperature, complications, FLR and duration of hospital stay after hepatectomy. Follow-up using outpatient examination and telephone interview was performed to detect carcinoma recurrence and other follow-up contents up to March 2016. Results (1)Before PRA+ PVE, SLVs of 2 patients were 1 103 mL and 1 132mL, FLRs of 2 patients were respectively 417 mL and 297 mL which occupied the SLV at the percentage of 37.8% and 26.2% respectively. (2)After PRA+ PVE treatment, there were no changes in liver function and fever. After PRA+ PVE treatment, FLR of 2 patients increased to 652 mL and 522 mL, respectively, which occupied the SLV at the percentage of 59.1% and 46.1% respectively, with increased rates of 56.4% and 75.6% and time of FLR hyperplasia of 10 days and 17 days. The two patients received successful hepatectomy, without intraoperative red blood cell infusion. (3)At postoperative day 3, albumin (Alb), alanine transaminase (ALT), aspartate transaminase (AST) and total bilirubin (TBil) of liver function were 28.0 g/L, 63 U/L, 39 U/L and 19.0 μmol/L in patient 1 with a temperature of 38 degree, and 24.3 g/L, 78 U/L, 11 U/L and 38.1 μmol/L in patient 2 with a normal temperature. Liver function of 2 patients was improved after conservative treatment. No severe complications were occurred. Rescan of CT showed the FLR of patients continued increasing. The duration of hospital stay of 2 patients was 10 days and 14 days, respectively. Conclusion PAPEP for HCC with insufficient FLR is safe and effective. Key words: Liver neoplasms; Associating liver partition and portal vein ligation for staged hepatectomy; Microwave ablation; Radiofrequency ablation; Future liver remrant; Planned hepatectomy