Sequential Transcatheter Arterial Chemoembolization and Portal Vein Embolization versus Portal Vein Embolization Only before Major Hepatectomy for Patients with Hepatocellular Carcinoma

Abstract

Sequential TACE and PVE before surgery is a safe and effective method to increase the rate of hypertrophy of the FLR and leads to longer overall and recurrence-free survival in patients with HCC.

A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90

“…24 These findings were replicated in subsequent larger studies, which also showed an improvement in both overall and disease-free survival in patients undergoing sequential treatment as opposed to PVE alone. 25,26 However, in these studies, the mean increase in percentage of FLR achieved in the PVE + TACE arms was only 7.3-22%, which was significantly less than that usually reported with PVE in the literature. 7 The current systematic review demonstrated that unilobar Y90 SIRT resulted in significant hypertrophy of the contralateral liver lobe.…”

Contra-lateral liver lobe hypertrophy after unilobar Y90 radioembolization: An alternative to portal vein embolization?

“…This approach was first shown to result in good FLR hypertrophy, with no increased risk of liver failure, as might be expected after occlusion of the liver's dual blood supply [11] . These findings were replicated in subsequent larger studies, which also showed an improvement in both overall and disease-free survival in patients undergoing sequential treatment as opposed to PVE alone [12,13] . However, in these studies, the mean increase in percentage of FLR achieved in the PVE + TACE arms was only 7.3%-22%, which was significantly less than that reported with PVE in the rest of the literature.…”

Current advances made in the surgical treatment of hepatocellular carcinoma

“…Thus, the response to PVE represents a valid dynamic stress test before major LR. 48 It has been shown that sequential selective transarterial chemoembolization (TACE) before PVE can increase the rate of hypertrophy, 48,49 which may be effective for treatment of HCC in the event of inadequate FLR hypertrophy. As an additional means of anticipating postoperative liver failure, there are several reports using volumetric data from Computed Tomography (CT) to evaluate FLR volume proportional to body weight, body surface area, and TLV, 50,51 and to determine the hypertrophy rate from the FLR/TLV ratio.…”