Application Of Portal Vein Chemo-embolization To Major Liver Resection For Initially Unresectable Primary And Secondary Liver Tumors

【Objective】To study the volume of the embolized liver and the nonembolized liver before and after the portal vein chemoembolization(PVCE), the liver function, serum CEA and AFP before and after PVCE, the liver function, serum CEA and AFP before and after the major hepatectomy. To investigate the surgical treatment of initially unresectable primary and secondary hepatic malignancies.【Methods】For a patient with multiple and bilobar colonic liver metastases, the first-stage hepatectomy consisted in a radical resection of the sigmoid colon carcinoma and hepatic left lateral segment. Subsequently, under the guidance of ultrasonography and X-ray, a right portal vein chemoembolization(PVCE) was performed by means of a percutaneous approach through the left portal branch to induce atrophy of the right hemiliver and hypertrophy of the left hemiliver. The volume of liver was evaluated with three-dimensional CT scan 2,4 weeks after PVCE.5 weeks after PVCE, a second-stage hepatectomy was planned to resect the right hemiliver. The volume of liver was evaluated with three-dimensional CT scan 2,4 weeks after PVCE.For a patient with huge hepatocellular carcinoma(HCC), transcatheter arterial chemoembolization (TACE) were performed and this was followed by PVCE 1 week later.4 weeks after PVCE, a right trisegmentectomy was planned to resect the right liver tumor. The volume of liver was evaluated with three-dimensional CT scan 2,4 weeks after PVCE.【Results】4 weeks after PVCE, right lobe was induced to atrophy remarkably and left lobe was induced compensatory hypertrophy.For the patient with colonic liver metastases,4 weeks after PVCE, the volume of the right lobe decreased from pre-PVCE 1380.0cm3 to post-PVCE 740.2cm3,. The future liver remnant of the left lobe increased from pre-PVCE 435.1cm3 to post-PVCE 624.4cm3. The ratio of future liver remnant to total estimated liver volume increased from pre-PVCE 25.6%to pos-PVCE 50.0%. The postoperative course was uneventful. The liver function and serum CEA decreased to the normal level. The patient was followed up for 18 months, no tumor recurs.For the patient with huge hepatocellular carcinoma, the volume of the right trisegment decreased from pre-PVCE 1685.4cm3 to post-PVCE 1228.1cm3. The future liver remnant of the left lateral segment for the HCC increased from pre-PVCE 151.5 cm3 to post-PVCE 560.2cm3. The ratio of future liver remnant to total estimated liver volume increased from pre-PVCE 13.6%to pos-PVCE 43.1%. The postoperative course was uneventful. The liver function and serum AFP decreased to the normal level. The patient was followed up for 8 months, no tumor recurs.【Conclusion】1,PVCE can prevent hepatic function failure after major hepatectomy.2,PVCE allows more patients with previously unresectable liver tumors to benefit from resection.