Zhang CW, Dou CW, Zhang XL, Liu XQ, Huang DS, Hu ZM, Liu J. Simultaneous transcatheter arterial chemoembolization and portal vein embolization for patients with large hepatocellular carcinoma before major hepatectomy. World J Gastroenterol 2020; 26(30): 4489-4500 [PMID: 32874060 DOI: 10.3748/wjg.v26.i30.4489]
Corresponding Author of This Article
Jie Liu, MD, Associate Professor, Surgeon, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 481 Binwen Road, Binjiang District, Hangzhou 310014, Zhejiang Province, China. atianlx1226@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
World J Gastroenterol. Aug 14, 2020; 26(30): 4489-4500 Published online Aug 14, 2020. doi: 10.3748/wjg.v26.i30.4489
Simultaneous transcatheter arterial chemoembolization and portal vein embolization for patients with large hepatocellular carcinoma before major hepatectomy
Cheng-Wu Zhang, Chang-Wei Dou, Xin-Long Zhang, Xi-Qiang Liu, Dong-Shen Huang, Zhi-Ming Hu, Jie Liu
Cheng-Wu Zhang, Chang-Wei Dou, Xi-Qiang Liu, Dong-Shen Huang, Zhi-Ming Hu, Jie Liu, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Xin-Long Zhang, Department of General Surgery, Aksu Area First Hospital, Aksu 843000, Xinjiang Uygur Autonomous Region, China
Author contributions: Zhang CW, Dou CW and Zhang XL contributed equally to this work; Zhang CW, Huang DS and Liu J designed this study; Dou CW and Liu J wrote the manuscript; Zhang XL, Hu ZM and Liu XQ prepared the tables and figures.
Supported bythe Medical Health Science and Technology Project of the Zhejiang Provincial Health Commission, No. 2016KYA009 and No. 2020KY044.
Institutional review board statement: The study was approved by the ethics committee of Zhejiang Provincial People’s Hospital (No.2019KY181) and followed the declaration of Helsinki.
Informed consent statement: Written informed consent was obtained from all enrolled patients.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Jie Liu, MD, Associate Professor, Surgeon, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 481 Binwen Road, Binjiang District, Hangzhou 310014, Zhejiang Province, China. atianlx1226@163.com
Received: March 30, 2020 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 Processing time: 137 Days and 5.2 Hours
ARTICLE HIGHLIGHTS
Research background
Sequential transarterial chemoembolization (TACE) and portal vein embolization (PVE) can improve the clinical outcomes and survival of patients with large hepatocellular carcinoma (HCC). However, the sequential treatment needs long wait time that can allow tumor growth and nullify treatments' benefits.
Research motivation
No study has ever compared the results of simultaneous TACE and PVE vs. sequential TACE and PVE or vs. PVE alone.
Research objectives
To evaluate the effect of simultaneous TACE and PVE before major hepatectomy in patients with large HCC and to compare their clinical outcome with sequential TACE+PVE or PVE only.
Research methods
Fifty-one patients with large HCC who underwent PVE combined with or without TACE prior to major 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.
Research results
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 two 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.
Research conclusions
Simultaneous TACE and PVE is a safe and effective approach to increase FLR volume for patients with large HCC who need major hepatectomy.
Research perspectives
Although the data were extracted from a prospective database, portal pressure data were not available because portal pressure was not routinely measured in our center. Prospective studies are needed to verify the present preliminary evidence, with available data of portal pressure. Multicenter, randomized controlled trials with large sample size and long-term follow-up should be conducted to confirm our results.
