title: New frontiers in the management of advanced hepatocellular carcinoma. "A new look to an old problem".
abstract: OBJECTIVE
  To evaluate the benefits of two-stage liver surgery with main portal branch ligation and transection combined with transarterial targeting locoregional neo and adjuvant immunochemotherapy in patients suffering from hepatocellular carcinoma.
  
  
  METHODS
  43 consecutive patients underwent two-stage liver surgery for advanced hepatocellular carcinoma. First we performed ligation and transection of the main portal vein branch corresponding to the liver lobe occupied by the tumor. Subsequently we introduced an arterial jet port catheter towards the hepatic artery via the gastroduodenal artery. After locoregional transarterial targeting immunochemotherapy regimen the patient underwent a second laparotomy for hemihepatectomy. Following surgery, locoregional transarterial targeting immunochemotherapy was given to all patients via the arterial port of the gastroduodenal artery as an adjuvant treatment.
  
  
  RESULTS
  Mean survival was 41 months. There were no operative deaths.
  
  
  CONCLUSIONS
  Two-stage liver surgery and transarterial targeting locoregional immunochemotherapy is the favorable option of treatment for advanced hepatocellular carcinoma. It not only results in an increase in the overall survival of these patients, but also increases the rate of resectability of these tumors by the hepatobiliary surgeon.
authors.affiliation: Department of Surgical Oncology, Henry Dunant Hospital, Athens, Greece. iasg@iasg.org
authors.forename: N J
authors.initials: NJ
authors.lastname: Lygidakis
authors.forename: Gurusharan
authors.initials: G
authors.lastname: Singh
authors.forename: E
authors.initials: E
authors.lastname: Bardaxoglou
authors.forename: G
authors.initials: G
authors.lastname: Sgourakis
authors.forename: M
authors.initials: M
authors.lastname: Pedonomou
authors.forename: J
authors.initials: J
authors.lastname: Nestoridis
authors.forename: A
authors.initials: A
authors.lastname: Maliotakis
authors.forename: G
authors.initials: G
authors.lastname: Dedemadi
authors.forename: E K
authors.initials: EK
authors.lastname: Solomou
authors.forename: Maria
authors.initials: M
authors.lastname: Alamani
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D016461:Chemoembolization, Therapeutic; D017024:Chemotherapy, Adjuvant; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007167:Immunotherapy; D008026:Ligation; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D014057:Tomography, X-Ray Computed