title: Sequential preoperative arterial and portal venous embolizations in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatic resection is the only curative treatment for large hepatocellular carcinoma (HCC). Sequential, preoperative, selective transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) allow feasible and safe major hepatic resections to be performed in HCC patients with chronic liver disease.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Seventeen HCC patients who underwent preoperative PVE following selective TACE for planned major hepatic resections were enrolled. The indications for PVE were determined using the volumetric ratio of the future remnant liver parenchyma and the indocyanine green retention ratio at 15 minutes.
  
  
  METHODS
  Preoperative TACE and PVE.
  
  
  METHODS
  Tumor characteristics and blood test results before and after TACE and PVE, changes in the volumes of the liver segments after PVE, the feasibility of major hepatic resections, and short- and long-term patient prognoses.
  
  
  RESULTS
  The liver function test results transiently worsened after TACE and PVE but returned to baseline levels within 1 (after TACE) or 2 (after PVE) weeks. Within 2 weeks after PVE, 22% +/- 4% hypertrophy of the nonembolized segments was obtained; subsequent major hepatic resections were feasible in 16 patients. Four minor complications (25%) were experienced postoperatively; however, liver failure did not occur. The 5-year overall and disease-free survival rates after curative resection were 55.6% and 46.7%, respectively.
  
  
  CONCLUSIONS
  Sequential TACE and PVE contribute to both the broadening of surgical indications and the safety of major hepatic resections performed in HCC patients with damaged livers. The long-term outcome of this treatment strategy is satisfactory.
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. AOKI-2SU@h.u-tokyo.ac.jp
authors.forename: Taku
authors.initials: T
authors.lastname: Aoki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Akira
authors.initials: A
authors.lastname: Matsukura
authors.forename: Keiji
authors.initials: K
authors.lastname: Sano
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D002454:Cell Differentiation; D016461:Chemoembolization, Therapeutic; D018450:Disease Progression; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011300:Preoperative Care; D012189:Retrospective Studies
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase