Zhang Shenyu, Song Ruipeng, Hou Changlong, Yao Huanzhang, Xu Jun, Zhou Hangcheng, Li Shaopeng, Cai Wei, Fei Yipeng, Meng Fanzheng, Yin Dalong, Wang Jiabei, Zhang Shugeng, Liu Yao, Wang Jizhou, Liu Lianxin
Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People's Republic of China.
Department of Intervention, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People's Republic of China.
J Hepatocell Carcinoma. 2025 Feb 5;12:219-229. doi: 10.2147/JHC.S495304. eCollection 2025.
Liver venous deprivation (LVD; simultaneous portal vein embolization and hepatic vein embolization) has been the latest surgical strategy for rapid future liver remnant (FLR) hypertrophy. The aim of this study was to assess the feasibility, safety, and efficacy of simultaneous LVD following hepatic arterial chemoembolization (TACE-LVD) before major hepatectomy for hepatocellular carcinoma (HCC).
A retrospective analysis of the outcomes of 23 HCC patients who underwent TACE-LVD at our center between October 2019 and October 2023 was conducted. An assessment of postoperative complications, FLR volume, liver function, and tumor response was performed.
All patients successfully underwent TACE-LVD. No other serious complications occurred except in 1 patient who underwent puncture drainage due to excessive pleural effusion. Following TACE-LVD, transaminase levels peak two days before rapidly decreasing and return to preoperative levels within one week. The ratio of FLR to standardized liver volume increased from 35.9% (interquartile range [IQR], 8.6) to 46.4% (IQR, 8.2), with a mean degree of hypertrophy and kinetic growth rate of 13.2% (IQR, 5.4) and 4.4% (IQR, 1.8) per week, respectively. At the first assessment after TACE-LVD, most patients exhibited sufficient FLR for hepatectomy, except for 4 patients with cirrhosis. The modified response evaluation criteria for solid tumor assessment revealed a disease control rate of 95.7%, with only 1 patient (Barcelona Clinic Liver Cancer stage C) developing intrahepatic disease progression.
TACE-LVD seems to be a feasible, safe, and effective strategy for rapid FLR hypertrophy. Moreover, TACE-LVD may be a therapeutic choice if insufficient FLR hypertrophy precludes resection. This strategy warrants further exploration.
肝静脉剥夺术（LVD；同时进行门静脉栓塞和肝静脉栓塞）是促进未来肝余体积（FLR）快速增大的最新手术策略。本研究旨在评估在肝细胞癌（HCC）大肝切除术前进行肝动脉化疗栓塞术（TACE-LVD）后同步LVD的可行性、安全性和有效性。
对2019年10月至2023年10月期间在本中心接受TACE-LVD的23例HCC患者的结局进行回顾性分析。对术后并发症、FLR体积、肝功能和肿瘤反应进行评估。
所有患者均成功接受TACE-LVD。除1例因胸腔积液过多接受穿刺引流的患者外，未发生其他严重并发症。TACE-LVD后，转氨酶水平在迅速下降前两天达到峰值，并在一周内恢复到术前水平。FLR与标准化肝脏体积的比值从35.9%（四分位间距[IQR]，8.6）增加到46.4%（IQR，8.2），平均肥大程度和动态生长率分别为每周13.2%（IQR，5.4）和4.4%（IQR，1.8）。在TACE-LVD后的首次评估中，除4例肝硬化患者外，大多数患者的FLR足以进行肝切除术。实体瘤评估的改良反应评估标准显示疾病控制率为95.7%，只有1例患者（巴塞罗那临床肝癌分期C期）出现肝内疾病进展。
TACE-LVD似乎是一种可行、安全且有效的促进FLR快速增大的策略。此外，如果FLR增大不足而无法进行切除，TACE-LVD可能是一种治疗选择。该策略值得进一步探索。
