Safety and Efficacy of Liver Venous Deprivation Following Transarterial Chemoembolization Before Major Hepatectomy for Hepatocellular Carcinoma.

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS
Than-Van Sy, Le Thanh Dung, Bui-Van Giang, Nguyen Quang Nghia, Ninh Viet Khai, Cao Manh Thau, Pham Gia Anh, Trinh Hong Son, Nguyen Minh Duc
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Abstract

Objective: This study aimed to evaluate the safety and efficacy of liver venous deprivation (LVD) following transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC).

Methods: Between January 2021 and December 2022, HCC patients indicated for hepatectomy with initial insufficient future liver remnant (FLR) underwent LVD after TACE to induce preoperative liver hypertrophy.

Results: Twenty-seven HCC patients with a median age of 55 years underwent LVD. No TACE or LVD procedure-associated complications occurred, except for 1 case presenting with grade A liver failure after LVD (then recovered after 7 days). The FLR volume was 29.3% (interquartile range [IQR] = 7.5) and 48.9% (IQR = 8.6) of the total liver volume before and after LVD, respectively (p < 0.001). The degree of hypertrophy and FLR hypertrophy rate were 14.8% (IQR = 8.4) and 55.2% (IQR = 36.7), respectively. All 27 patients demonstrated sufficient FLR after LVD (24 patients at three weeks post-LVD, one at six weeks, and two at ten weeks), but only 21 patients accepted surgery. Postoperative histopathology showed 16 patients with cirrhosis and five with mild fibrosis (F1, F2). One patient presented with severe intraoperative bleeding due to damage of left hepatic vein and developed grade C liver failure, then died on day 32 postoperation.

Conclusion: LVD following TACE seems to be a safe, effective, and feasible method of inducing significant FLR regeneration in HCC, even in well-selected cirrhotic livers. Comparative studies with a large patient population and multicenter data are needed for further evaluation.

Abstract Image

Abstract Image

肝细胞癌大肝切除术前经动脉化疗栓塞后肝静脉剥夺的安全性和有效性。
目的:本研究旨在评价肝静脉剥夺(LVD)在肝细胞癌(HCC)患者经动脉化疗栓塞(TACE)后的安全性和有效性。方法:在2021年1月至2022年12月期间,需要肝切除术且初始未来肝残余不足(FLR)的HCC患者在TACE后接受LVD以诱导术前肝肥大。结果:27例中位年龄55岁的HCC患者行了LVD。除1例LVD后出现A级肝功能衰竭(7天后恢复)外,无TACE或LVD手术相关并发症发生。LVD前后FLR体积分别为总肝体积的29.3%(四分位数间距[IQR] = 7.5)和48.9% (IQR = 8.6),差异有统计学意义(p < 0.001)。肥厚程度14.8% (IQR = 8.4), FLR肥厚率55.2% (IQR = 36.7)。所有27例患者在LVD后均表现出足够的FLR (LVD后3周24例,6周1例,10周2例),但只有21例患者接受了手术。术后组织病理学显示16例肝硬化,5例轻度纤维化(F1, F2)。1例患者术中因左肝静脉损伤出现严重出血,并发C级肝功能衰竭,术后第32天死亡。结论:TACE后的LVD似乎是一种安全、有效和可行的方法,可以诱导HCC患者显著的FLR再生,即使在经过精心挑选的肝硬化患者中也是如此。为了进一步评估,需要对大量患者群体和多中心数据进行比较研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
ACS Applied Bio Materials
ACS Applied Bio Materials Chemistry-Chemistry (all)
CiteScore
9.40
自引率
2.10%
发文量
464
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