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Sequential TACE and PVE for Hepatocellular Carcinoma

  • Hiroshi ImamuraEmail author
  • Yasuji Seyama
  • Masatoshi Makuuchi
  • Norihiro Kokudo
Chapter

Abstract

Although hepatic resection is the treatment of choice for large hepatocellular carcinoma (HCC) whenever feasible, it is often precluded by the presence of underlying chronic liver disease. Portal vein embolization (PVE) has been introduced to extend the indications for major hepatic resection to increase the safety of the surgical procedure. Prior to undertaking PVE, the following possibilities should be considered: failure to induce hypertrophy of the nonembolized liver part from underlying fibrosis or cirrhosis, tumor growth acceleration after occlusion of blood flow, and low PVE efficacy due to arterioportal shunts. Sequential transcatheter arterial embolization (TACE) and PVE can be applied to HCC patients to overcome such difficulties. In the literature, as well as our own experience, this double preparation was well tolerated, enhanced the hypertrophy process in the nonembolized liver part, and suppressed tumor growth during the preparation period. Furthermore, PVE also functioned as a preoperative test to select suitable patients for major liver resection. Sequential TACE and PVE are therefore effective preoperative interventions in HCC patients scheduled for major liver resection.

Keywords

Portal vein embolization Hepatocellular carcinoma Transcatheter arterial ­embolization Liver resection Sequential transcatheter arterial embolization 

Abbreviations

AFP

Alpha-fetoprotein

AST

Aspartate transaminase

ALT

Alanine transaminase

CT

Computed tomography

DCP

Des-γ-carboxy prothrombin

FRL

Future remnant liver

HCC

Hepatocellular carcinoma

ICG-R15

Indocyanine green retention rate at 15 min

PVE

Portal vein embolization

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Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Hiroshi Imamura
    • 1
    Email author
  • Yasuji Seyama
    • 2
  • Masatoshi Makuuchi
    • 3
  • Norihiro Kokudo
    • 4
  1. 1.Department of Hepatobiliary-Pancreatic SurgeryJuntendo School of MedicineTokyoJapan
  2. 2.Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Graduate School of MedicineUniversity of TokyoTokyoJapan
  3. 3.Japanese Red Cross Medical CenterTokyoJapan
  4. 4.Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan

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