Preoperative portal vein embolization and surgical resection in patients with hepatocellular carcinoma and small future liver remnant volume: comparison with transarterial chemoembolization.
BACKGROUND
Preoperative portal vein embolization (PVE) increases the future liver remnant (FLR) volume, thus enabling surgical resection in patients with small FLR volume. It is unclear, however, if this approach can enhance survival in patients with hepatocellular carcinoma (HCC). We therefore compared the outcomes of preoperative PVE and surgical resection with transarterial chemoembolization (TACE).


METHODS
Changes in FLR volumes were analyzed in 32 HCC patients who underwent preoperative PVE and surgical resection. Long-term outcomes were compared with 64 TACE-treated patients matched for gender, Child-Turcotte-Pugh class, tumor size and number, serum alpha-fetoprotein levels, and UICC stage.


RESULTS
In the PVE group, the baseline ratio of FLR/total estimated liver volumes (TELV) was 27.6 +/- 7.2%. Following PVE, FLR volume increased 34% (336.5 vs 449.4 mL, P < .001) and the ratio of FLR/TELV increased from 27.6 +/- 7.2 to 36.9 +/- 8.1% (P < .001). There was no mortality associated with PVE or surgical resection. The 5-year survival rate was significantly higher in the PVE group than in the TACE group (71.9% vs 45.6%, P = .03). Multivariate analysis showed that treatment modality was an independent predictive factor for survival (odds ratio 2.05, 95% confidence interval 1.01-4.16, P = .046).


CONCLUSIONS
Preoperative PVE enables surgical resection in HCC patients with small FLR volume and improves patient survival compared with TACE.
Seo
Dong Dae
DD
Department of Internal Medicine, University of Inje College of Medicine, Sanggye Paik Hospital, Seoul, Korea.
Lee
Han Chu
HC
Jang
Myoung Kuk
MK
Min
Hyun Ju
HJ
Kim
Kang Mo
KM
Lim
Young Suk
YS
Chung
Young-Hwa
YH
Lee
Yung Sang
YS
Suh
Dong Jin
DJ
Ko
Gi-Young
GY
Lee
Young-Joo
YJ
Lee
Sung-Gyu
SG
D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000502:physiology*; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome