Sequential transcatheter arterial chemoembolization and portal vein embolization versus portal vein embolization only before major hepatectomy for patients with hepatocellular carcinoma.
OBJECTIVE
To evaluate the safety and efficacy of sequential transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) prior to surgery in hepatocellular carcinoma (HCC) patients and to compare the clinical outcome of the combined procedure with that of a matched group of patients undergoing PVE alone.


METHODS
From 1997 to 2008, 135 patients with HCC underwent sequential TACE and PVE (n = 71) or PVE alone (n = 64) before right hepatectomy. PVE was performed mean 1.2 months after TACE. In both groups, computed tomography (CT) and liver volumetry were performed before and 2 weeks after PVE to assess degree of left lobe hypertrophy.


RESULTS
Baseline patient and tumor characteristics were similar in the two groups. After PVE, the chronological changes of liver enzymes were similar in the two groups. The mean increase in percentage future liver remnant (FLR) volume was higher in the TACE + PVE group (7.3%) than in the PVE-only group (5.8%) (P = 0.035). After surgery, incidence of hepatic failure was higher in the PVE-only group (12%) than in the TACE + PVE (4%) group (P = 0.185). Overall (P = 0.028) and recurrence-free (P = 0.001) survival rates were significantly higher in the TACE + PVE group than in the PVE-only group.


CONCLUSIONS
Sequential TACE and PVE before surgery is a safe and effective method to increase the rate of hypertrophy of the FLR and leads to longer overall and recurrence-free survival in patients with HCC.
Department of Radiology, University of Ulsan College of Medicine, Seoul, Korea.
Hyunkyung
H
Yoo
Jin Hyoung
JH
Kim
Gi-Young
GY
Ko
Kyoung Won
KW
Kim
Dong Il
DI
Gwon
Sung-Gyu
SG
Lee
Shin
S
Hwang
D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D002404:Catheterization; D016461:Chemoembolization, Therapeutic; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate