Treatment Of Metastatic Hepatic Carcinoma With Selective Portal Vein Embolization Combined With Transcatheter Arterial Chemoembolization: A Prospective Randomized Controlled Study

Objective: The study explores the curative effects of portal vein embolization combined with transcatheter arterial chemoembolization to treat metastatic hepatic carcinoma, the influences upon the patients'liver volume and function, as well as the postoperative complications of the treatment. It also evaluates the effects and security of the combination therapy in contrast with other common treatments to explore the more reasonable treatment method of metastatic hepatic carcinoma.Methods: 49 patients with metastatic hepatic carcinoma,who are unable to or refuse to undergo resection of liver are randomly divided into control group and treatment group. The control group is treated with transcatheter arterial chemoembolization, while the treatment group is given portal vein embolization combined with transcatheter arterial chemoembolization. The variation of liver function, untoward effects and postoperative complications of both groups are observed for 3 to 14 months. The study evaluates the effects and security of the combination therapy by comparing with the single treatment and thus explores the clinical feasibility and validity of portal vein embolization.Results: (1)Curative effects : the effective rate of the treatment group is 69.5%, higher than that of the control group, which is 34.6%(P=0.04); the total longest diameter of tumor of the treatment group decreases to 6.45±2.51cm after the operation, while that of the control group reduces from 10.34±3.12cm to 8.33±3.71 cm. The curative effects of the treatment group are better than the control group.(2)Liver volume variation: no obvious postoperative change of liver volume is found in the control group; the preoperative volume of unembolized lobe of the treatment group is (481±251)cm3 ,accounting for(30.9±15.3)% of the whole liver volume, which is changed into postoperative(523±250)cm3,(548±249)cm3,(552±249)cm3 in two, four and eight weeks, accounting for (33.8±15.1)%,(35.1±14.9)%,(35.1±15.5)% respectively.(3)Postoperative liver function: no obvious change of serum albumin is found in both groups (P>0.05). The first and third days after the operation see a distinct increase in ALT,AST and TB(P<0.05)and the seventh day an obvious reduce ,which is of no statistical significance(P>0.05).By contrast, ALT,AST and TB are higher than that of the control group on the first and third postoperative days(P<0.05).Still no statistical significance on the seventh and fourteenth days.(4)Untoward effects and postoperative complications: 3 cases of complications relating to PVE are found in treatment group with an incidence rate of 13.0%. No serious complications develop and the symptoms and incidences of postoperative untoward effects are similar in both group.Conclusions: Portal vein embolization combined with transcatheter arterial chemoembolization which can effectively inhibit and reduce metastatic hepatic carcinoma without any increase of untoward effects is a safe and effective choice of treating metastatic hepatic carcinoma.