Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2015; 21(32): 9666-9670
Published online Aug 28, 2015. doi: 10.3748/wjg.v21.i32.9666
Radioembolisation and portal vein embolization before resection of large hepatocellular carcinoma
Fikri Bouazza, Arthur Poncelet, Camilo Alejandro Garcia, Philippe Delatte, Jean Luc Engelhom, Maria Gomez Galdon, Amélie Deleporte, Alain Hendlisz, Bruno Vanderlinden, Patrick Flamen, Vincent Donckier
Fikri Bouazza, Arthur Poncelet, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
Camilo Alejandro Garcia, Bruno Vanderlinden, Patrick Flamen, Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
Philippe Delatte, Jean Luc Engelhom, Radiology, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
Maria Gomez Galdon, Pathology, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
Amélie Deleporte, Digestive Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
Alain Hendlisz, Digestive Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
Vincent Donckier, Abdominal Surgery, Institut Jules Bordet, Centre de Chirurgie Hépato-Biliaire de l’ULB, Université Libre de Bruxelles, 1000 Brussels, Belgium
Author contributions: Bouazza F, Flamen P and Donckier V performed research and wrote the paper; Poncelet A, Garcia CA, Delatte P, Engelhom JL, Gomez Galdon M, Deleporte A and Vanderlinden B performed research; Hendlisz A wrote the paper; all authors finally approved the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institut Jules Bordet, Universite Libre de Bruxelles (ethical committee reviewing 2025).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict of interest. None of the authors received any financial support for this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vincent Donckier, MD, PhD, Professor of Surgery, Abdominal Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger-Bordet, 1, 1000 Brussels, Belgium. vincent.donckier@erasme.ulb.ac.be
Telephone: +32-2-5413158 Fax: +32-2-5413141
Received: December 11, 2015
Peer-review started: December 12, 2015
First decision: January 8, 2015
Revised: February 20, 2015
Accepted: April 9, 2015
Article in press: April 9, 2015
Published online: August 28, 2015
Processing time: 259 Days and 23.1 Hours
Abstract

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.

Keywords: Hepatocellular carcinoma; Chronic liver disease; Radioembolisation; Portal vein embolization; Hepatectomy; Cirrhosis

Core tip: Surgical treatment of hepatocellular carcinoma in patients with chronic liver disease is challenging due to the contradictory need to perform a radical tumor resection while preserving a maximal amount of tumor-free remnant liver. Preoperative treatment may be indicated for tumor downsizing and to promote hypertrophy of the future remnant liver. We report the case of a cirrhotic patient undergoing extended right hepatectomy for a large hepatocellular carcinoma after transarterial radioembolization and right portal vein embolization. Our results suggest that this approach is feasible and safe and may represent a new therapeutic option before major hepatectomy in patients with liver injury.