Radioembolisation and portal vein embolization before resection of large hepatocellular carcinoma.
Resectability of hepatocellular carcinoma in patients with chronic liver disease is dramatically limited by the need to preserve sufficient remnant liver in order to avoid postoperative liver insufficiency. Preoperative treatments aimed at downsizing the tumor and promoting hypertrophy of the future remnant liver may improve resectability and reduce operative morbidity. Here we report the case of a patient with a large hepatocellular carcinoma arising from chronic liver disease. Preoperative treatment, including tumor downsizing with transarterial radioembolization and induction of future remnant liver hypertrophy with right portal vein embolization, resulted in a 53% reduction in tumor volume and compensatory hypertrophy in the contralateral liver. The patient subsequently underwent extended right hepatectomy with no postoperative signs of liver decompensation. Pathological examination demonstrated a margin-free resection and major tumor response. This new therapeutic sequence, combining efficient tumor targeting and subsequent portal vein embolization, could improve the feasibility and safety of major liver resection for hepatocellular carcinoma in patients with liver injury.
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Fikri
F
Bouazza
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Arthur
A
Poncelet
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Camilo Alejandro
CA
Garcia
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Philippe
P
Delatte
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Jean Luc
JL
Engelhom
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Maria
M
Gomez Galdon
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Amélie
A
Deleporte
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Alain
A
Hendlisz
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Bruno
B
Vanderlinden
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Patrick
P
Flamen
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
Vincent
V
Donckier
D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011169:Portal Vein / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
D019275:Radiopharmaceuticals
Chronic liver disease; Cirrhosis; Hepatectomy; Hepatocellular carcinoma; Portal vein embolization; Radioembolisation