Selective Regional Feeding Vessel Occlusion: A New Alternative for Percutaneous Ablation of Hepatocellular Carcinoma Adjacent to Gastrointestinal Tract when Artificial Ascites Failed

Abstract

Conventional percutaneous radiofrequency ablation for peripheral hepatocellular carcinoma (HCC) has a high risk of injuring adjacent gastrointestinal tract. The aim of this study was to evaluate the efficacy and safety of selectively regional feeding vessel occlusion as a new alternative for treating HCC adjacent to gastrointestinal tract when artificial ascites failed. From June 2014 to January 2016, 9 patients with 9 hypervascular target HCCs (mean, 3.0±0.7cm) were included in this study. The target tumors were located at the hepatic marginal angle (segment 2/3/6) and adjacent to gastrointestinal tract. Structure of feeding vessels were identified with multimodal ultrasound technologies including color doppler ultrasound, 2-dimensional and 4-dimensional contrast-enhanced ultrasound. A unipolar Cool-tip electrode was used to selectively occlude the feeding vessel of a subsegmental and tumor-burden region. Initial complete response (ICR), local tumor progression (LTP), intrahepatic distant recurrence (IDR) and complications were observed. Successful occlusions were achieved in 7/9 (77.8%) of the tumors. ICR was achieved in 7/7 (100%) of the tumors in 1-month evaluation. After a mean follow-up period of 12.4±8.5 months, LTP was observed in 1/7 (14.3%) of the tumors after a delay of 4.7 months. IDR was observed in 5/7 (71.4%) of the tumors after a mean delay of 8.0±5.7 months. Minor complication occurred in 2/7 (28.6%) of the patients. No major complication occurred. Selective regional feeding vessel occlusion assisted by multimodal ultrasound has the potential to serve as an effective and safe alternative to treat HCC adjacent to gastrointestinal tract when artificial ascites failed.