Clinical efficacy of TACE combined with PVE versus percutaneous microwave ablation liver partition with PVE for planned hepatectomy for hepatocellular carcinoma with insufficient remnant liver volume
10.3760/cma.j.cn113884-20230407-00103
- VernacularTitle:TACE联合门静脉栓塞术与微波消融肝脏分隔联合门静脉栓塞术治疗剩余肝脏体积不足肝细胞癌的临床疗效
- Author:
Hongguo YANG
1
;
Zhiming HU
;
Jiaze XU
;
Chengwu ZHANG
;
Jungang ZHANG
;
Minjie SHANG
;
Bing ZHANG
Author Information
1. 浙江省立同德医院肝胆胰外科，杭州 310012
- Keywords:
Carcinoma, hepatocellular;
Portal vein embolization;
Liver regeneration;
Liver partition;
Planned hepatectomy
- From:
Chinese Journal of Hepatobiliary Surgery
2023;29(6):418-422
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the safety and clinical efficacy of transcatheter arterial chemoembolization (TACE) combined with portal vein embolization (PVE) and percutaneous microwave ablation liver partition with PVE for planned hepatectomy in patients with hepatocellular carcinoma (HCC) with insu-fficient remnant liver volume.Methods:The clinical data of 51 patients with initially unresectable HCC due to insufficient remnant liver volume admitted to Zhejiang Provincial Tongde Hospital and Zhejiang Provincial People’s Hospital from January 2014 to December 2021 were retrospectively analyzed, including 37 males and 14 females, aged (56.7±11.2) years old. Patients were divided into two groups according to the treatment prior to hepatectomy: percutaneous microwave ablation liver partition combined with PVE (AP group, n=12) and TACE with PVE (TP group, n=39). Patients who successfully underwent planned hepatectomy in the above two groups were marked as resectable AP group ( n=10) and the resectable TP group ( n=29), respectively. Clinical data including the waiting time for surgery and the incidence of complications were analyzed. Patients were followed up by telephone or outpatient review. Kaplan-Meier and log-rank analysis were used for survival comparison. Results:The FLR growth rate was higher in AP group [76.5% (65.3%, 81.6%)] than that in TP group [31.4% (28.2%, 41.9%), P<0.01]. The waiting time for planned hepatectomy in the resectable AP group was 12.0 (11.3, 14.5) d, shorter than that in the resec-table TP group [21.0 (15.0, 29.0) d, P<0.05]. The incidence of postoperative complications was higher in the resectable AP group than that in the resectable TP group [80.0% (8/10) vs. 27.6% (8/29), P<0.05]. There was one perioperative death in the resectable AP group. The survival rate after PVE was lower in AP group than that in TP group, and the survival rate after hepatectomy was also lower in the resectable AP group than that in the resectable TP group (all P<0.05). Conclusion:For HCC patients with insufficient FLR, TACE combined with PVE is a safe and effective method for enlargement of liver remnant, whereas percutaneous microwave ablation liver partition with PVE showed a poor prognosis, despite the higher rate of FLR enlargement and shortened the waiting time for planned hepatectomy.
