Abstract
To evaluate the safety and efficacy of sequential transcatheter arterial chemoembolization (TACE )and portal vein embolization (PVE) before major hepatectomy for patients with hepatocellur carcinoma (HCC). In this retrospective case-control study, data were collected from patients who underwent sequential TACE and PVE prior to major hemihepactectomy. Liver volumes were measured by computed tomography volumetry before TACE, and preoperation to assess degree of future remnant liver (FRL) hypertrophy and to check whether intro- or extrohepatic metastasis existed. Liver function was monitored by biochemistry after TACE, prior to and after major hepatectomy. Mean average FRL volume increased 32.3-71.4% (mean 55.4%) compared with preoperative FRL volume. After TACE, liver enzymes were elevated, but returned to normal in four weeks. During PVE and resection, no patient had intro- or extrohepatic metastasis. Sequential TACE and PVE is an effective method to improve resection opportunity, expand the scope of surgical resection, and greatly reduce postoperative intra- and extrahepatic metastasis.
Highlights
Tumor resection is still a curative method for patients with hepatocellular carcinoma (HCC), most patients diagnosed with hepatocellur carcinoma (HCC) lost opportunity for surgery (Ribero et al, 2007; Hwang et al, 2009)
Liver volumes were measured by computed tomography volumetry before transcatheter arterial chemoembolization (TACE), and preoperation to assess degree of future remnant liver (FRL) hypertrophy and to check whether intro- or extrohepatic metastasis existed
Extensive liver resection is contraindicated in many patients with HCC because of the future remnant liver volume (FRLV) is too small to receive operation, which could increase the risk of postoperative hepatic dysfunction
Summary
Tumor resection is still a curative method for patients with hepatocellular carcinoma (HCC), most patients diagnosed with HCC lost opportunity for surgery (Ribero et al, 2007; Hwang et al, 2009). Extensive liver resection is contraindicated in many patients with HCC because of the future remnant liver volume (FRLV) is too small to receive operation, which could increase the risk of postoperative hepatic dysfunction. Previous studies confirmed that the size of FRLV before hepatic resection is an independent risk factor for mortality and postoperative liver failure (Ribero et al, 2007). Portal vein embolization (PVE) has been widely accepted as an effective means to increase the future remnant liver volume (FRLV) in patients requiring extensive liver resection (Palavecino et al, 2009). With the development of research , there is growing evidence that PVE stimulates the growth of the FRL and affects tumor size in embolized liver segment (Ribero et al, 2007). PVE can promote hypertrophy of the FRL, it can’t control the progress of the tumor, which may leads to patients with HCC lose opportunities for operation if intrahepatic or extrahepatic tumor metastasis during the period between PVE and Hepatectomy (Wilmar et al, 2009)
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