ABSTRACT
When feasible, hepatic resection is the treatment of choice for large hepatocellular carcinoma (HCC). Because HCC is often developed on chronic liver disease, which is known to have limited regeneration capacity, major hepatic resections are often contraindicated. Portal vein embolization (PVE) has been introduced to extend the indications for major hepatic resection and to increase the safety of the surgical procedure. However, hypertrophy after PVE is often less than in normal liver. It has been suggested that preoperative sequential arterial embolization and PVE have a strong anticancer effect and could increase the rate of hypertrophy more than PVE alone. In our experience, sequential arterial embolization and PVE effectively increase the future liver remnant and induce a high rate of complete tumor necrosis. This combined procedure should broaden the indication for major resection in chronic liver disease.
KEYWORDS
Liver-HCC - liver-intervention - liver-portal vein embolization
REFERENCES
-
1
De Baere T, Roche A, Vavasseur D et al..
Portal vein embolization: utility for inducing left hepatic lobe hypertrophy before surgery.
Radiology.
1993;
188
73-77
-
2
Denys A, Lacombe C, Schneider F et al..
Portal vein embolization with n-butyl cyanoacrylate before partial hepatectomy in patients with hepatocellular carcinoma and underlying cirrhosis or advanced fibrosis.
J Vasc Interv Radiol.
2005;
16
1667-1674
-
3
Tanaka H, Hirohashi K, Kubo S, Shuto T, Higaki I, Kinoshita H.
Preoperative portal vein embolization improves prognosis after right hepatectomy for hepatocellular carcinoma in patients with impaired hepatic function.
Br J Surg.
2000;
87
879-882
-
4
Azoulay D, Castaing D, Krissat J et al..
Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver.
Ann Surg.
2000;
232
665-672
-
5
Kinoshita H, Sakai K, Hirohashi K, Igawa S, Yamasaki O, Kubo S.
Preoperative portal vein embolization for hepatocellular carcinoma.
World J Surg.
1986;
10
803-808
-
6
Nagino M, Nimura Y, Kamiiya J et al..
Immediate increase in arterial blood flow in embolized hepatic segments after portal vein embolization: CT demonstration.
AJR Am J Roentgenol.
1998;
171
1037-1039
-
7
Wakabayashi H, Ishimura K, Okano K et al..
Is preoperative portal vein embolization effective in improving prognosis after major hepatic resection in patients with advanced-stage hepatocellular carcinoma?.
Cancer.
2001;
92
2384-2390
-
8
Llovet J M, Real M I, Montana X et al..
Arterial embolization or chemoembolization versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomized controlled study.
Lancet.
2002;
359
1734-1739
-
9
Lo C M, Nghan H, Tso W K et al..
Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma.
Hepatology.
2002;
35
1164-1171
-
10
Llovet J M, Bruix J.
Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival.
Hepatology.
2003;
37
429-442
-
11
Cammà C, Schepis F, Orlando A et al..
Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials.
Radiology.
2002;
224
47-54
-
12
Kokudo N, Makuuchi M.
Current role of portal vein embolization/hepatic artery chemoembolization.
Surg Clin North Am.
2004;
84
643-657
-
13
Lau W Y, Yu S C, Lai E C, Leung T W.
Transarterial chemoembolization for hepatocellular carcinoma.
J Am Coll Surg.
2006;
202
155-168
-
14
Nakao N, Miura K, Takahashi H et al..
Hepatocellular carcinoma: combined hepatic, arterial, and portal venous embolization.
Radiology.
1986;
161
303-307
-
15
Yamakado K, Hirano T, Kato N et al..
Hepatocellular carcinoma: treatment with a combination of transcatheter arterial chemoembolization and transportal ethanol injection.
Radiology.
1994;
193
75-80
-
16
Yamakado K, Nakatsuka A, Tanaka N, Matsumura K, Takase K, Takeda K.
Long-term follow-up arterial chemoembolization combined with transportal ethanol injection used to treat hepatocellular carcinoma.
J Vasc Interv Radiol.
1999;
10
641-647
-
17
Ogata S, Belghiti J, Farges O, Varma D, Sibert A, Vilgrain V.
Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma.
Br J Surg.
2006;
93
1091-1098
-
18
Aoki T, Imamura H, Hasegawa K et al..
Sequential preoperative arterial and portal venous embolizations in patients with hepatocellular carcinoma.
Arch Surg.
2004;
139
766-774
-
19
Di Stefano D R, de Baere T, Denys A et al..
Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients.
Radiology.
2005;
234
625-630
-
20
Madoff D C, Abdalla E K, Vauthey J N.
Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care.
J Vasc Interv Radiol.
2005;
16
779-790
-
21
Farges O, Belghiti J, Kianmanesh R et al..
Portal vein embolization before right hepatectomy: prospective clinical trial.
Ann Surg.
2003;
237
208-217
-
22
Iannaccone R, Piacentini F, Murakami T et al..
Hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: helical CT and MR imaging findings with clinical-pathologic comparison.
Radiology.
2007;
243
422-430
-
23
Wakabayashi H, Ishimura K, Okano K et al..
Application of preoperative portal vein embolization before major hepatic resection in patients with normal or abnormal liver parenchyma.
Surgery.
2002;
131
26-33
Valérie VilgrainM.D.
Department of Radiology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris
APHP, 100 bd du Général Leclerc, 92110 Clichy, France
Email: valerie.vilgrain@bjn.aphp.fr
