Preoperative Portal Vein Embolization and Hepatic Arterial Chemoembolization in the Combined Treatment of Patients with Liver Malignancies

Abstract

Aim. To improve the efficiency of treatment of patients with liver malignancies. Material and Methods. 27 patients with liver malignancies underwent preoperative portal vein embolization without previous hepatic arterial chemoembolization (group 1). Group 2 consisted of 42 patients in whom 1 – 6 hepatic arterial chemoembolizations were made before preoperative portal vein embolization. Hepatic arterial chemoembolizations was continued after portal vein embolization in all patients. Results. In both groups preoperative portal vein embolization resulted in hypertrophy of the contralateral liver segments by 29.6% on the average; up to 30% of liver volume in normal organ function and up to 40% in case of impaired function. 38 (55%) patients were operated including 15 (55.6%) in group 1 and 23 (55%) in group 2. Among 12 patients without surgery in group 1 intrahepatic tumor progression was noted in 5 (18.2%) cases within 38–231 days. Among 19 nonoperated patients in group 2 tumor progression was also observed in 5 (11.9%) cases within 49–837 days. Conclusion. Preoperative portal vein embolization with previous hepatic arterial chemoembolization is an effective combination of neoadjuvant therapy of malignant liver tumors. This combination allows you to expect necessary hypertrophy during longer period after preoperative portal vein embolization with relatively low risk of intrahepatic tumor progression in 11.9% of patients versus 18.2% in patients without prior hepatic arterial chemoembolization