OBJECTIVETo analyze the origin of the feeding artery of the retroperitoneal invasion caused by massive hepatocellular carcinoma (HCC) and the characteristics of DSA. To explore the approaches to completely embolize the tumor blood supply and to assess the technical success rates, the safety and effectiveness with a purpose of improving the patients survival rates and living quality.

METHODSAfter complete ultraselective arterial embolization via hepatic artery for the 75 patients with retroperitoneal invasion led by massive HCC, those showing lipiodol deposition inconsistance compared with CT or MRI underwent the ultraselective catheterization to find potential tumor feeding arteries and then the subsequent chemoembolization. 3-6 months after operation CT or MRI was used to evaluate the efficacy. RETURNS: Retroperitoneal lesions were supplied by the posterior branch of right inferior phrenic artery (64%, 48/75), the right adrenal artery (33.3%, 25/75) and the right-side first lumbar artery (2.7%, 2/75), respectively. The success rates of ultraselective catheterization to tumor feed arteries was 100% (75/75). 3-6 months after embolization, the cases of complete and most-part iodine oil filling in the lesions were 72 (96%) and 3 (4%) respectively. The sizes of the lesions showed significant reduce (55, 73.3%), reduce (15, 20%) and no change (5,6.7%). Survival rates of 6, 12, 24 and 36 months after TACE were 90.7% (68/75), 81.3% (61/75), 49.3% (37/75) and 40% (30/75) respectively.

CONCLUSIONThe supply arteries of retroperitoneal invasion led by massive HCC come from the posterior branch of right phrenic artery, the right adrenal artery and the right first lumbar artery. Ultraselective TACE has high technical success rates, hight safety, and excellent effectiveness. The complete embolization of tumor feed artery can significantly increase the survival rates and living quality of these patients.