Published online Aug 14, 2020. doi: 10.3748/wjg.v26.i30.4489
Peer-review started: March 30, 2020
First decision: May 29, 2020
Revised: June 10, 2020
Accepted: July 14, 2020
Article in press: July 14, 2020
Published online: August 14, 2020
Sequential transarterial chemoembolization (TACE) and portal vein embolization (PVE) are associated with long time interval that can allow tumor growth and nullify treatments' benefits.
To evaluate the effect of simultaneous TACE and PVE for patients with large hepatocellular carcinoma (HCC) prior to elective major hepatectomy.
Fifty-one patients with large HCC who underwent PVE combined with or without TACE prior to hepatectomy were included in this study, with 13 patients in the simultaneous TACE + PVE group, 17 patients in the sequential TACE + PVE group, and 21 patients in the PVE-only group. The outcomes of the procedures were compared and analyzed.
All patients underwent embolization. The mean interval from embolization to surgery, the kinetic growth rate of the future liver remnant (FLR), the degree of tumor size reduction, and complete tumor necrosis were significantly better in the simultaneous TACE + PVE group than in the other groups. Although the patients in the simultaneous TACE + PVE group had a higher transaminase levels after PVE and TACE, they recovered to comparable levels with the other two groups before surgery. The intraoperative course and the complication and mortality rates were similar among the three groups. The overall survival and disease-free survival were higher in the simultaneous TACE + PVE group than in the other two groups.
Simultaneous TACE and PVE is a safe and effective approach to increase FLR volume for patients with large HCC before major hepatectomy.
Core tip: Simultaneous transarterial chemoembolization (TACE) and portal vein embolization (PVE) is a safe and effective approach to increase the future liver remnant volume quickly in a short time, and it has achieved a longer median overall survival and disease-free survival time compared with sequential TACE and PVE or PVE-only for patients with large hepatocellular carcinoma before major hepatectomy.