Tumor compression-induced portal obstruction and selective transarterial chemoembolization increase functional liver volume in the unobstructed area, facilitating successful resection of a large HCC.
A 62-year-old man with hepatitis B was admitted for treatment of a large hepatocellular carcinoma. The right portal vein was completely obstructed by tumor compression. Although we initially planned a right trisectionectomy as curative hepatectomy, the percentage of future remnant liver volume (%RLV) and the percentage of functional liver volume (%RFLV) were 31.2% and 41.3%, respectively. Because %RFLV showed marginal tolerability for curative hepatectomy and %RLV was very low, we opted for transarterial chemoembolization of segment IV and the right lobe containing the tumor as an approach to selectively reduce liver volume and abolish liver function. One month later, %RLV and %RFLV had dramatically increased to 46.6% and 67.2%, resulting in curative hepatectomy. Our results suggest that tumor compression-induced portal obstruction and selective transarterial chemoembolization increase %RFLV much more than %RLV. This may represent a useful approach in preoperative management in patients with large hepatocellular carcinomas to improve %RFLV for hepatic resection.
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Ryuma
R
Tokunaga
Hiromitsu
H
Hayashi
Toshiro
T
Masuda
Kosuke
K
Mima
Akira
A
Chikamoto
Hiroshi
H
Tanaka
Kei
K
Horino
Takatoshi
T
Ishiko
Hiroshi
H
Takamori
Toru
T
Beppu
Hideo
H
Baba
D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000601:surgery*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003251:Constriction, Pathologic; D003952:Diagnostic Imaging; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D015607:Stents