Simultaneous super-selective hepatic arterial and portal vein embolization for staged hepatectomy in patients with hepatocellular carcinoma and cirrhosis

Abstract

Objective To study the feasibility and safety of simultaneous super-selective hepatic arterial and portal vein embolization for staged hepatectomy (ASAPS) in the treatment of patients with hepatocellular carcinoma (HCC) and cirrhosis. Methods The clinical data of 8 patients with HCC who underwent ASAPS at the First Affiliated Hospital of the Army Medical University from December 2016 to January 2018 were retrospectively analyzed. All the patients, including 7 males and 1 female with an average age of 44.3±9.2, were diagnosed to have cirrhosis with insufficient volume of future liver remnant (FLR). Portal vein embolization (PVE) and super-selective hepatic arterial embolization (SHAE) were performed simultaneously. The patients were then closely monitored for the volumes of FLR. Once the FLR achieved the target volume, a second staged resectional surgery would be performed. The postoperative major complications, laboratory tests and patient long-term survival were studied. Results The ratio of FLR to the average standard liver volume (SLV) increased from (28.5±5) % to (49.6±7.3) % following the first-stage procedure. All the patients underwent liver resection successfully. The average second-stage operation time was 342.6±92.8 min, and the intraoperative blood loss was 743.8±432.1 ml. Both the postoperative serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were elevated remarkably and then dropped to the near normal levels. All the patients were discharged home without any severe complications. Among them, 3 patients relapsed early in the postoperative period, 5 survived without recurrence, and 3 survived for over 1 year. Conclusions The first-stage surgery of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) using ASAPS was minimally invasive. The volume growth rate of the FLR after ASAPS was comparable to that of the conventional first stage of ALPPS. In conclusion, ASAPS is a promising alternative to the traditional ALPPS as the first-line treatment of patients with insufficient FLR. Key words: Carcinoma, hepatocellular; Embolization, therapeutic; Hepatectomy; Liver cirrhosis; Future liver remnant