Zalinski Stéphane, Scatton Olivier, Randone Bruto, Vignaux Olivier, Dousset Bertrand
Department of Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université Descartes, Paris, France.
World J Gastroenterol. 2008 Nov 28;14(44):6869-72. doi: 10.3748/wjg.14.6869.
Most patients with hepatocellular carcinoma (HCC) are not eligible for curative treatment, which is resection or transplantation. Two recent series have emphasized the potential benefits of preoperative arterio-portal embolization prior to surgical resection of such tumours. This preoperative strategy offers a better disease free survival rate and a higher rate of total tumor necrosis. In case of non resectable HCC it is now widely accepted that transarterial chemoembolization (TACE) leads to a better survival when compared to conservative treatment. Thus, the question remains whether combined portal vein embolization (PVE) may enhance the proven efficiency of TACE in patients with unresectable HCC. We herein report the case of a 56-year-old cirrhotic woman with a voluminous HCC unsuitable for surgical resection. Yet, complete tumour necrosis and prolonged survival could be achieved after a combined porto-arterial embolization. This case emphasizes the potential synergistic effect of a combined arterio-portal embolization and the hypothetical survival benefit of such a procedure, in selected patients, with HCC not suitable for surgery or local ablative therapy.
大多数肝细胞癌（HCC）患者不适合进行根治性治疗，即手术切除或移植。最近的两个系列研究强调了在这类肿瘤手术切除前进行术前动脉门静脉栓塞的潜在益处。这种术前策略可提供更好的无病生存率和更高的肿瘤完全坏死率。对于不可切除的HCC，与保守治疗相比，经动脉化疗栓塞（TACE）能带来更好的生存率，这一点目前已被广泛接受。因此，问题仍然是，联合门静脉栓塞（PVE）是否可以提高TACE在不可切除HCC患者中的已证实疗效。我们在此报告一例56岁的肝硬化女性患者，患有巨大的HCC，不适合手术切除。然而，在进行联合门静脉动脉栓塞后，实现了肿瘤完全坏死并延长了生存期。该病例强调了联合动脉门静脉栓塞的潜在协同效应，以及在选定的不适合手术或局部消融治疗的HCC患者中，这种治疗方法可能带来的生存益处。
