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
Processing time: 137 Days and 5.2 Hours
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.
No study has ever compared the results of simultaneous TACE and PVE vs. sequential TACE and PVE or vs. PVE alone.
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.
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.
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.
Simultaneous TACE and PVE is a safe and effective approach to increase FLR volume for patients with large HCC who need major hepatectomy.
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.