Management of large hepatocellular carcinoma by sequential transarterial chemoembolization and portal vein embolization: a systematic review of the literature.

INTRODUCTION

Currently, the treatment of HCC is multidisciplinary. Surgery remains the gold standard although the management of large hepatocellular carcinoma remains challenging. Hepatic resection is increasingly performed with ever-expanding indications. However, postoperative liver failure remains a major cause of death after major hepatic resections. The purpose of this review is to report the results of large hepatocellular carcinoma (>5 cm or more nodules in the same lobe) management using sequential transarterial chemoembolization (TACE) and portal vein embolization (PVE) before major liver resections.

EVIDENCE ACQUISITION

A literature search was performed using PubMed, Scopus, and Web of Science (WoS) from cited English publications. The search was last conducted in December 2014. Search phrases included "hepatocellular carcinoma", "liver resection", "transarterial chemoembolization", and "portal vein embolization". Clinical and survival parameters were extracted. When there was more than one publication from the same surgical team and/or authors, only the last publication in chronological order was considered for the study. Case reports, abstracts, letters, editorials, and expert opinions were not considered for the drafting of the study. After application of selective criteria, only 4 original studies were analyzed.

EVIDENCE SYNTHESIS

No meta-analyses were found in the search. Among the 4 selected publications, 3 originated from Asia and 1 from Europe. The total number of patients treated with the method considered was 171 (range: 18-71). The mean size of the tumor was >5 cm. The gain of volume of the future remnant liver (FRL) was higher in the group with TACE+PVE as compared to the group with PVE alone (12% vs. 8%). A major hepatectomy was carried out in 166 patients (97%). Mortality rate ranged between 0% and 11%. The 5-year overall survival was between 43% and 72% and the 5-year recurrence-free survival was between 37% and 61%.

CONCLUSIONS

Sequential TACE+PVE prior to a major hepatectomy for HCC was feasible, safe, and with excellent 5-year overall survival rates reported to be between 43% and 72%.