This article presented our experience on transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) before hepatic resection for huge hepatocellular carcinoma with cirrhosis.The preoperative future liver remnant/total estimated liver Volume (FLR/TELV) ratios of 5 patients were less than 40％,and preoperative TACE was implemented 3 weeks after PVE.In all these patients,right hepatectomy was successfully implemented.Preoperative TACE and PVE expanded the indication of hepatectomy,increased the safety of surgery and improved the curative rate.

Objective To study the use of contrast-enhanced ultrasound in diagnosing splenic arterial steal syndrome (SASS) after liver transplantation,and to compare the curative effect,safety and follow-up results of the different embolization methods in the treatment of SASS after liver transplantation.Methods From January 2005 to December 2017,41 patients after liver transplantation in our hospital developed splenic artery steal syndrome and were treated with splenic arterial embolization.All these patients underwent ultrasound,and in 19 patients contrast-enhanced ultrasonography was also done to detect the presence of splenic artery steal.The findings were confirmed by angiography.These patients then underwent splenic arterial embolization.In 32 patients coil embolization was done (group A) and in 9 patients embolization was assisted with Amplatzer occluders (group B).Results In all the 41 patients with SASS,angiography after splenic artery embolization showed the second and third order arterial branches in the liver increased in number and in diameter with good blood flow compared with those before treatment.The postoperative blood flow and pattern on ultrasound returned to normal.In group A,12 patients (12/32,37.5％) developed splenic infarction,including 11 patients with partial splenic infarction,and 1 patient developed a splenic abscess after complete splenic infarction.In group B,two patients developed partial splenic infarction (2/9,22.2％).All the patients with splenic infarct had no clinical symptoms.No treatment was required except for the patient who developed splenic abscess after complete splenic infarction.The patient recovered well after treatment with antibiotics and splenic abscess drainage.There was no other complications.Conclusions Contrast-enhanced ultrasound provided early diagnosis of splenic artery steal after liver transplantation.Interventional splenic artery embolization was safe and effective to treat splenic arterial steal syndrome after liver transplantation.Coil embolization assisted with Amplatzer occluders was better than the traditional coil embolization with more accurate embolization site and fewer complications.

The aims of bridging treatments before liver transplantation is to prevent the tumor from progressing to exceed the liver transplantation standards during the waiting period of patients with hepatocellular carcinoma (HCC), and to downgrade the HCC to meet the liver transplantation standards so as to reduce the postoperative tumor recurrence rate. Conventional transcatheter arterial chemoembolization (cTACE) has the disadvantages of large systemic adverse reactions and great influence on liver function. Drug-eluting beads (DEBs) are a new type of embolization material. Compared with cTACE, DEB-TACE can continuously and stably release chemotherapeutic drugs locally on the tumor for several weeks. Moreover, the concentration of the chemotherapeutic drug in the blood circulation is extremely low, which can effectively avoid systemic reactions caused by chemotherapy drugs, and is more effective in thebridging treatments of liver transplantation. In this paper, the current status and research progress of DEB-TACE treatment before liver transplantation for liver cancer were reviewed.

Objective:To study the short-term safety and efficacy of small diameter drug-eluting beads-transcatheter arterial chemoembolization (DEB-TACE) for patients with liver cancer before liver transplantation.Methods:From Mar 2018 to Dec 2019, 47 patients underwent small diameter DEB-TACE for liver cancer before liver transplantation. There were 39 males and 8 females, aged 24 to 70 years (median 51.5 years). Analysis of tumor size, tumor number and complications was conducted after DEB-TACE. After DEB-TACE, tumor response evaluation was done according to the modified response evaluation criteria in solid tumors criteria. Ananlyze the elimination rate and downstaged rate during liver transplantation waiting period. For patients who underwent liver transplantation, the pathological findings and the tumor recurrence of patients were analysed.Results:There were 46 patients Child-Pugh A, 1 patient Child-Pugh B. A solitary liver cancer was found in 17 patients, and multiple tumors in 30 patients. The lesion size was (30.8±17.7)mm. For the 47 patients who together underwent 50 times DEB-TACE. The technical success rate was 100.0%, the complete response rate 27.7%(13/47), partial response rate 51.1%(24/47), stable disease rate 17.0%(8/47), and progressive disease rate 4.2%(2/47). For the 22 patients who met the Milan cirteria and were awaiting for transplantation, the elimination from transplantation rate was 0. For the 25 patients who are beyond the cirteria and who underwent DEB-TACE, 84.0% (21/25) of patients were downstaged to within the University of California, San Francisco cirteria and 56.0% (14/25) to within the Milan cirteria. For the 35 patients who underwent liver transplantation, pathology showed that complete necrosis rate was 39.4%(13/33), and more than 50 % necrosis was achieved in 26 of 33 patients(78.8%). No significant treatment related complications were observed. Only 3.0%(1/33) of patients suffered from tumor recurrence.Conclusion:Small diameter DEB-TACE for liver cancer was an effective procedure with a favorable safety profile and promising results in tumor necrosis rates.

Objective:To evaluate the safety and efficacy of irreversible electroporation ablation for liver cancer.Methods:A retrospective study was conducted on 21 patients who underwent irreversible electroporation ablation for liver cancer from September 2018 to August 2019. There were 17 males and 4 females, with a median age of 57.9 (48, 69) years old. Complications were graded according to the Clavien Dindo complication grading system. Tumor response was evaluated by the improved evaluation standard of solid tumor efficacy. Clinical data such as tumor size and operation time were recorded. Tumor recurrence and survival outcomes were followed-up until August 27, 2020.Results:All patients had well-compensated cirrhosis (Child-Pugh A 20 cases, Child-Pugh B 1 case). There was no persistent deterioration of liver function after ablation. The diameter of tumor ranged from 10 to 56 mm, with 7 patients having a tumor diameter over 3 cm. Each of the 21 patients received only once irreversible electroporation ablation and the technical success rate was 100%. The operation time was 2.3 (1.5, 3.5) h. All complications were Clavien Dindo grade Ⅰ, which included pain, fever and brachial plexus strain. Imaging examination 4 weeks after treatment showed a complete remission rate of 85.7% (18/21), a partial remission rate of 9.5% (2/21), a stable disease rate of 0(0/21), and a progressive disease rate of 4.8% (1/21). The objective remission rate was 95.2% (20/21). Overall recurrence rates were 9.5% (2/21) at 3 months and 23.8% (5/21) at 12 months. AFP at 3 and 12 months after treatment were (28.0±7.3) and (29.0±8.1) ng/ml, respectively, which were significantly lower than that before treatment (278.0±41.2) ng/ml ( t3m=-3.57, t12m=-4.12, P<0.05). Conclusion:Irreversible electroporation ablation was safe and effective in treating malignant liver tumors.

Objective:To investigate the clinical value of drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) in preoperative liver transplantation application of hepatocellular carcinoma beyond Milan standard.Methods:A total of 100 patients with hepatocellular carcinoma who were underwent liver transplantation exceeding Milan criteria were retrospectively analyzed from April 2013 to March 2019 at the Tianjin First Central Hospital. Of 72 males and 28 females were included, aged (50.3±7.8) years. Fifty patients who received preoperative DEB-TACE treatment were included in the DEB-TACE group. According to the tumor necrosis rate after liver transplantation, they were further divided into group A (complete tumor necrosis), group B (50%≤ tumor necrosis rate <100%) and group C (tumor necrosis rate <50%). Fifty patients with hepatocellular carcinoma who did not receive any preoperative treatment were included in the control group. DEB-TACE complications were analyzed. Their survival and recurrence were followed up. Survival analysis was performed by Kaplan-Meier method and survival rates were compared by log-rank test.Results:In the DEB-TACE group, the technical success rate of interventions was 100%(50/50) and 1 to 4(1.8±1.2) interventions were received. Post-DEB-TACE complications, included post-embolization syndrome in 18 cases (36.0%). Cumulative survival rates at 1, 2 and 3 years after liver transplantation in the DEB-TACE group were 96.0%, 90.0%, and 76.0%, respectively, which were better than the control group with 94.0%, 78.0%, and 54.0%. The differences were statistically significant (χ 2=6.62, P=0.015). The cumulative survival rates at 1, 2 and 3 years after liver transplantation for patients in group A+ B ( n=30) were 100.0%, 96.7% and 93.3% respectively, which were better than 94.0%, 78.0% and 54.0% for the control group, with statistically significant differences (χ 2=6.99, P=0.012). The cumulative survival rates after liver transplantation for group C compared with the control group were not statistically significant (χ 2=0.56, P=0.130). The results of the comparison of cumulative recurrence-free survival rates were consistent with the comparison of cumulative survival rates. Conclusion:In patients with liver cancer exceeding Milan criteria, DEB-TACE before liver transplantation is beneficial in improving the prognosis of patients.

Objective To evaluate the drug-eluting-beads (DEB)-TACE as down-stage therapy for hepatocellular carcinoma before liver transplantation.Methods Inclusion criteria:the hepatocellular carcinoma exceeding the standard of Milan criteria.From Jan 2016 to Jan 2018,30 patients received DEB-TACE as down-stage therapy for hepatocellular carcinoma before liver transplantation.4 weeks after DEB-TACE,the imaging examination was performed.The patients who received the liver transplantation,the pathological conditions were recorded and the tumor free survival of the patients was followed up.Results 30 patients received 30 times DEB-TACE successfully.76.7％ (23/30) patients was down-staged to meet UCSF criteria,53.3％ (16/30) patients was down-staged to meet Milan criteria.13 patients had being given liver transplantation,pathology showed that DEB-TACE achieved complete necrosis in 30.8 ％ (4/13)cases.No significant treatment related complications were observed.After liver transplantation 12 patients are alive with no tumor recurrence.The tumor recurrence rate after liver transplantation was 7.7％.Conclusion DEB-TACE is safe and effective as down-stage therapy for hepatocellular carcinoma before liver transplantation.