Therapeutics and Clinical Risk Management (May 2023)

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

  • Sy TV,
  • Dung LT,
  • Giang BV,
  • Nghia NQ,
  • Viet Khai N,
  • Manh Thau C,
  • Gia Anh P,
  • Hong Son T,
  • Minh Duc N

Journal volume & issue
Vol. Volume 19
pp. 425 – 433

Abstract

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Than-Van Sy,1,2,* Le Thanh Dung,1– 3,* Bui-Van Giang,4 Nguyen Quang Nghia,5 Ninh Viet Khai,5 Cao Manh Thau,6 Pham Gia Anh,6 Trinh Hong Son,6 Nguyen Minh Duc7 1Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam; 2Department of Radiology, Viet Duc University Hospital, Ha Noi, Vietnam; 3Department of Radiology, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam; 4Department of Radiology, Vinmec Healthcare System, Hanoi, Vietnam; 5Center of Organ Transplantation, Viet Duc University Hospital, Ha Noi, Vietnam; 6Department of Oncology, Viet Duc University Hospital, Ha Noi, Vietnam; 7Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam*These authors contributed equally to this workCorrespondence: Nguyen Minh Duc, Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam, Email [email protected]: 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.Keywords: hepatic vein embolization, hepatocellular carcinoma, liver hypertrophy, liver resection, liver venous deprivation, portal vein embolization

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