Application of sequential hepatic arterial and selective portal venous embolization prior to extended radical hepatectomy in patients with marginally resectable hepatocellular carcinoma
10.3760/cma.j.issn.1007-8118.2017.10.001
- VernacularTitle:术前序贯肝动脉化疗栓塞联合门静脉栓塞在临界肝切除肝癌治疗中的应用
- Author:
Lei YUAN
1
;
Xianwu LUO
;
Bin YI
;
Yao HUANG
;
Mingjia XIAO
;
Yang SHEN
;
Qingxiang GAO
;
Kaijian CHU
;
Xiaobing WU
;
Xiaoqing JIANG
Author Information
1. 200438,上海第二军医大学东方肝胆外科医院胆道一科
- Keywords:
Hepatocellular carcinoma;
Portal venous embolization;
Transcatheter arterial chemo-embolization;
Residual liver volume;
Two-stage hepatectomy
- From:
Chinese Journal of Hepatobiliary Surgery
2017;23(10):649-654
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the feasibility and efficacy of preoperative sequential transcatheter arterial chemoembolization (TACE) followed by selective portal venous embolization (PVE) in patients with marginally resectable hepatocellular carcinoma (HCC).The aim was to find out whether this combined procedure helped to increase the rate of extended radical liver resection.Methods From March 2009 to November 2016,29 patients with HCC which were marginally resectable underwent preoperative TACE combined with PVE were included into this study.All these patients were subsequently assessed to undergo radical hepatectomy.The complications,laboratory results,volume changes of each liver lobe and patient survival were analyzed.Results TACE combined with PVE was successful in all the 29 patients.There were no major complications.After the procedure,the volumes of the tumor and the part of the liver to be resected decreased to certain degree.The remnant liver volume (RLV) increased remarkably.The RLV were (395.4 ±58.7) cm3 and (599.2 ±75.2) cm3 before and after the procedure,respectively.The difference was significant (P ＜ 0.05).19 patients underwent radical hemihepatectomy or trisectionectomy,with a resection rate of 65.5％ (19/29).There were sufficient surgical margins in all the resected tumors.After operation,the 1-,3-,and 5-year survival rates were 58.8％,35.5％ and 17.6％,respectively.Conclusion For HCC patients who had marginally resectable HCC,preoperative TACE combined with PVE efficiently controlled the growth of the tumors,decreased the volume of the liver lobe with tumor,increased the RLV,and made it possible for a planned two-stage radical hepatectomy with sufficient surgical margin and better survival in a significant proportion of patients.
