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Chan KS, Tay WX, Cheo FY, Shelat VG. Preoperative transarterial chemoembolization (TACE) + liver resection versus upfront liver resection for large hepatocellular carcinoma (≥5 cm): a systematic review and meta-analysis. Acta Chir Belg 2023; 123:601-617. [PMID: 37681991 DOI: 10.1080/00015458.2023.2256539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/04/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) accounts for majority of primary liver cancer. Use of preoperative neoadjuvant transarterial chemoembolization (PN-TACE) may result in tumor shrinkage and improve resectability. This study aims to summarize the outcomes of PN-TACE versus upfront liver resection (Up-LR) in large HCC (≥5 cm). METHODS PubMed, Embase, The Cochrane Library, and Scopus were systematically searched till September 2022 for studies comparing PN-TACE versus Up-LR. The primary study outcomes were overall survival (OS), disease-free survival (DFS), and recurrence. Our secondary outcomes were postoperative morbidity and mortality. RESULTS There were 12 studies with 15 data sets including 3960 patients (PN-TACE n = 2447, Up-LR n = 1513). Majority (89.5%, n = 1250/1397) of patients had Child's A liver cirrhosis. Incidence of Child's B cirrhosis was higher in PN-TACE compared to Up-LR (Odds ratio (OR) 1.69, 95% CI: 1.18, 2.41, p = 0.004). Pooled hazard ratio (HR) for OS showed no significant difference between PN-TACE and Up-LR (HR 0.87, 95% CI: 0.64, 1.18, p = 0.37), but DFS was superior in PN-TACE (HR 0.79, 95% CI: 0.63, 0.99, p = 0.04). Subgroup analysis based on study design failed to show any significant effect in randomized controlled trials (n = 2/15 data sets). However, operating time (mean difference (MD) 31.94 min, 95% CI: 2.42, 61.45, p = 0.03) and blood loss (MD 190.93 ml, 95% CI: 10.22, 317.65, p = 0.04) were higher in PN-TACE. Intrahepatic and extrahepatic recurrence, post-operative morbidity and in-hospital mortality were comparable between PN-TACE and Up-LR. CONCLUSION In retrospective studies, PN-TACE resulted in superior DFS compared to Up-LR. However, this may be confounded by selection bias.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Xuan Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Feng Yi Cheo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Shinkawa H, Tanaka S, Takemura S, Amano R, Kimura K, Kinoshita M, Miyazaki T, Kubo S. Prognostic value of expanded liver transplantation criteria-the 5-5-500 rule-in patients with hepatic resection for intermediate-stage hepatocellular carcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:682-689. [PMID: 32578373 DOI: 10.1002/jhbp.792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study aimed to evaluate the prognostic impact of the 5-5-500 rule in patients after hepatic resection for the intermediate stage of hepatocellular carcinoma (HCC; The Barcelona Clinic Liver Cancer classification [BCLC] B). METHODS 177 patients had hepatic resection for BCLC-B HCC. The 5-5-500 rule was defined by tumor size ≤5 cm in diameter, tumor number ≤5, and α-fetoprotein ≤500 ng/mL. RESULTS The 3-, 5-, and 7-year recurrence-free survival rates were 22%, 14%, and 11% in patients within the 5-5-500 rule, and 16%, 10%, and 10% in patients beyond the 5-5-500 rule, respectively (P = .015). The 3-, 5-, and 7-year overall survival rates were 72%, 47%, and 34% in patients within the 5-5-500 rule, and 52%, 31%, and 25% in patients beyond the 5-5-500 rule, respectively (P = .035). Being beyond the 5-5-500 rule and liver cirrhosis were independent prognostic factors for recurrence-free survival. For overall survival, being beyond the 5-5-500 rule, age ≥65 years, Child-Pugh class B, and anti-hepatitis C antibody positive were identified as independent prognostic factors. CONCLUSIONS The 5-5-500 rule could predict prognosis in BCLC-B patients with hepatic resection. Hepatic resection might provide survival benefit for selected patients with BCLC-B HCC within the 5-5-500 rule.
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Affiliation(s)
- Hiroji Shinkawa
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shigekazu Takemura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ryosuke Amano
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenjiro Kimura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Kinoshita
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toru Miyazaki
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Segmental Arterial Mediolysis of Omental Arteries with Haemoperitoneum: Case Report with Embolization of the Left Omental Artery and Brief Review of Literature. Case Rep Radiol 2018; 2018:4749356. [PMID: 30112243 PMCID: PMC6077596 DOI: 10.1155/2018/4749356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/11/2018] [Indexed: 11/18/2022] Open
Abstract
Segmental arterial mediolysis of an omental artery is an exceptionally rare condition. A 69-year-old man presented with haemoperitoneum six days after being hospitalized due to pneumogenic sepsis. Computed tomography of the abdomen showed a short segment dilatation of an omental artery in the left upper abdomen, compatible with segmental arterial mediolysis. Angiographic examination revealed alterations of omental branches of the right gastroepiploic artery and an aneurysm of the left omental artery, both characteristic of segmental arterial mediolysis. Embolization of the left omental artery with use of N-butyl-2-cyanoacrylate was performed. The postinterventional course was uneventful with increase of haemoglobin levels and without symptoms of omental infarction. Transcatheter embolization in the setting of haemoperitoneum due to segmental arterial mediolysis of an omental branch is technically feasible and a valuable alternative to emergency operation.
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Hu S, Tu J, Jia Z, Huang Y, Jiang G. Transarterial embolization/chemoembolization therapy for hepatocellular carcinoma fed by adrenal artery: Preliminary results. Medicine (Baltimore) 2016; 95:e5762. [PMID: 28033293 PMCID: PMC5207589 DOI: 10.1097/md.0000000000005762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
To assess the value of transarterial embolization/chemoembolization (TAE/TACE) therapy via adrenal artery for patients with hepatocellular carcinoma (HCC). Patients with HCC who underwent TAE/TACE therapy via adrenal artery between May 2003 and October 2015 across 4 medical centers were identified. Clinical information, procedural data, and imaging data were analyzed to assess technical success, disease control, and survival rates. A t test was used to compare the differences in serum alpha-fetoprotein before and after treatment. A total of 23 patients (23 men; mean age, 54.6 ± 7.5 years; range, 37-72 years) were included in this study. All tumors were located under the capsule of the liver and adjacent to the adrenal gland (median tumor diameter, 8.2 cm). Lesions fed by the adrenal artery were demonstrated during initial TAE/TACE in 7 patients and during repeat TAE/TACE in 16 patients. The superior, middle, and inferior adrenal arteries were involved in 14, 3, and 6 patients, respectively. The technical success rate was 100%. The disease control rate at 3 months was 100%, with partial tumor response seen in 16 (69.6%) patients and stable disease seen in 7 (30.4%) patients. The cumulative survival rate from the time of TAE/TACE was 100% at 1 year. There were no embolization-related complications. TAE/TACE therapy via the adrenal arteries can improve the therapeutic efficacy of TAE/TACE and reduce the incidence of HCC recurrence and/or presence of residual HCC.
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Affiliation(s)
- Shibing Hu
- Department of Radiology, Gaochun People's Hospital, Gaochun
| | - Jianfei Tu
- Department of Radiology and Interventional Radiology, Li shui Central Hospital, Li shui
| | - Zhongzhi Jia
- Department of Interventional Radiology, The Second People's Hospital of Changzhou
| | - Yuanquan Huang
- Department of Interventional Radiology, The First People's Hospital of Changzhou, Changzhou, China
| | - Guomin Jiang
- Department of Interventional Radiology, The Second People's Hospital of Changzhou
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Park JH, Jeon UB, Kim TU, Lee JW, Choo KS, Yoon KT, Cho M. Chemoembolization for hepatocellular carcinoma supplied by the right gastric artery. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2015. [DOI: 10.18528/gii150006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Incidence and therapeutic frequency of extrahepatic collateral arteries in transcatheter arterial chemoembolization of hepatocellular carcinoma: Experience from 182 patients with survival time more than 3 years. Eur J Radiol 2015; 84:2555-63. [PMID: 26481483 DOI: 10.1016/j.ejrad.2015.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 08/08/2015] [Accepted: 10/02/2015] [Indexed: 11/21/2022]
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Evaluation of extrahepatic collateral arteries in hepatocellular carcinoma in three independent groups in a single center. Exp Ther Med 2015; 10:2366-2374. [PMID: 26668643 DOI: 10.3892/etm.2015.2822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 06/18/2015] [Indexed: 01/10/2023] Open
Abstract
To improve the efficacy of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), this study evaluated the prevalence and causes of extrahepatic arteries (EHAs) and identified feeding arteries in HCCs in three independent clinical groups in a single inverventional radiology center. Between November 2011 and September 2012, 942 cases of HCC were included in this retrospective study. The patients were treated in three independent groups of 285, 301 and 356 patients, respectively. Enhanced computed tomography, enhanced magnetic resonance imaging and digital subtraction angiography were reviewed retrospectively and correlations between the presence of tumor-feeding EHAs and tumor number, size and location in the liver, number of repeat TACE procedures and complications were assessed. There were 698 EHAs in the 942 cases of HCC, with 182, 233 and 283 EHAs in the three independent groups, respectively. Tumor size was associated with EHA formation; the percentages of patients with EHAs were 2.7±3.0, 5.5±0.5, 43.2±4.0, 61.8±5.2 and 93.4±1.8% with tumor sizes of 2-3, 3-5, 5-7, 7-9 and >9 cm, respectively. There were 159±19 EHAs in each group feeding tumors in peripheral locations in the liver, but only 48.7±6.8 in the central zone. The most common EHA was the right inferior phrenic artery, with a mean of 101.0±14.1 per group. The number of EHAs increased proportionally with the number of TACE sessions. The number of EHAs was positively associated with tumor size, peripheral location of the tumor and number of TACE sessions.
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Cazejust J, Bessoud B, Colignon N, Garcia-Alba C, Planché O, Menu Y. Hepatocellular carcinoma vascularization: from the most common to the lesser known arteries. Diagn Interv Imaging 2013; 95:27-36. [PMID: 23978434 DOI: 10.1016/j.diii.2013.04.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma is the sixth most common cancer throughout the world. It is almost exclusively arterially vascularized, unlike the vascularization of the liver, which has a dual supply with a portal component of 75 to 80% and an arterial component of 20 to 25%. The reference treatment for intermediary stages of the Barcelona (B) classification is hepatic artery chemoembolization. The aim of chemoembolization is to inject the tumor chemotherapy into the artery and then to embolize the artery (or arteries), which supply the tumor. For this, knowledge of the anatomy of the hepatic artery is essential. Approximately 55% of the patients belong to the modal distribution, although numerous anatomical variants exist and must be recognized. In addition, primarily non-hepatic arteries may contribute to the vascularization of some hepatocellular carcinomas. Furthermore, new arterial supplies can be recruited by tumors after surgical or chemoembolization treatments. The aim of this article is to describe the different arteries, which may vascularize hepatocellular carcinomas. These arteries must be looked for, recognized, and reported by the radiologist on cross-section examinations in the pre-treatment assessment.
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Affiliation(s)
- J Cazejust
- Department of Radiology, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - B Bessoud
- Department of Radiology, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - N Colignon
- Department of Radiology, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - C Garcia-Alba
- Department of Radiology, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - O Planché
- Department of Radiology, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Y Menu
- Department of Radiology, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Gao S, Yang RJ, Dong JH. Hepatocellular carcinoma with blood supply from parasitized omental artery: angiographic appearance and chemoembolization. Chin J Cancer Res 2013; 24:207-12. [PMID: 23359452 DOI: 10.1007/s11670-012-0207-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/19/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze angiographic appearance of hepatocellular carcinoma (HCC) with blood supply from parasitized omental artery (POA), and evaluate the technical feasibility, safety and therapeutic efficacy of chemo-embolization via the POAs. METHODS A total of 1,221 HCC patients who had undergone chemoembolization procedures were evaluated retrospectively. The evaluated indexes included the incidence rate of POAs, success rate of superselective catheterization, post-reaction after chemoembolization, and the cumulative survival rates. RESULTS Totally 1,221 HCC patients had undergone 3,639 chemoembolization procedures, and 32 patients with POAs were enrolled, with 97 POAs found in 76 angiography procedures, giving an incidence rate of 2.09%. POA was observed mostly at the right lobe and left medial lobe except the segment II, and 62 POAs underwent superselective catheterization with microcatheter, giving a success rate of 63.9%. The angiographic appearance was: (1) hypertrophic POAs participating in tumor staining (n=28); (2) stiff and distorted POA (n=11), displaced due to tumor's oppression (n=8); and (3) defective tumor staining close to either gastrocolic omentum distribution or liver capsule (n=7). In 19 patients, chemoembolization via POAs was performed successfully (A group), while the remaining 13 patients failed (B group). Except 1 acute edema pancreatitis case, no serious complication was recorded. The cumulative survival rates of 6-, 12-, 18- and 24-month were 78.9%, 47.4%, 31.6% and 21.1% respectively for A group; correspondingly, 61.5%, 30.8%, 15.4% and 7.7%% for B group, in which 2 patients died of ruptured HCC. CONCLUSION Chemoembolization with microcatheter via POAs is a relatively safe, feasible and valuable method.
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Affiliation(s)
- Song Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Interventional Therapy Department, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Chemoembolization Via Branches from the Splenic Artery in Patients with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2011; 35:90-6. [DOI: 10.1007/s00270-011-0109-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/12/2011] [Indexed: 11/25/2022]
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Seki A, Hori S, Kobayashi K, Narumiya S. Transcatheter arterial chemoembolization with epirubicin-loaded superabsorbent polymer microspheres for 135 hepatocellular carcinoma patients: single-center experience. Cardiovasc Intervent Radiol 2010; 34:557-65. [PMID: 20821211 DOI: 10.1007/s00270-010-9975-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 08/09/2010] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the safety, clinical outcomes, and hepatic artery damage after transcatheter arterial chemoembolization (TACE) with epirubicin-loaded superabsorbent polymer microspheres (ELM-TACE) in patients with hepatocellular carcinoma (HCC) in a single center in Japan. MATERIALS AND METHODS This embolic agent is the original form of microspheres, which has the same composition and nature as HepaSpheres. Between May 2007 and June 2009, 135 patients with unresectable HCC who underwent ELM-TACE were enrolled. Embolization through extrahepatic collaterals was performed in 27 (20.0%) patients. Tumor response was evaluated using European Association for the Study of the Liver criteria at 1 and 6 months after initial ELM-TACE. RESULTS All procedures were successfully performed. The median number of TACE per patient was 1.7 sessions (range 1-5), and the mean epirubicin dose per session was 19.7 mg (range 2.0-60.0). Local pooling within target tumors was observed during TACE in 34 (25.2%) patients, and in 14 (10.4%) of the patients, gelatin sponge particles were added after the microspheres until each pooling disappeared. No serious adverse events associated with TACE occurred, and the incidence of postembolization syndrome was ≤17.8%. The 1- and 6-month tumor response rates were 56.3 and 52.6%, respectively. The overall 1- and 2-year survival rates were 73.7 and 59.0%, respectively. Among 99 evaluated patients, 90 (90.9%) were found to have no hepatic artery damage after initial ELM-TACE. CONCLUSION ELM-TACE is safe and effective treatment for unresectable HCC and is associated with low frequency of postembolization syndrome and minimal damage to the hepatic artery.
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Affiliation(s)
- Akihiko Seki
- Department of Radiology, GateTower Institute for Image Guided Therapy, 1-Rinku Orai, Izumisano, Osaka, 598-0048, Japan.
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Yoon CJ, Chung JW, Cho BH, Jae HJ, Kang SG, Kim HC, Choi YH, Jeon UB, Park JH. Hepatocellular carcinoma in the caudate lobe of the liver: angiographic analysis of tumor-feeding arteries according to subsegmental location. J Vasc Interv Radiol 2008; 19:1543-50; quiz 1550. [PMID: 18755606 DOI: 10.1016/j.jvir.2008.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 07/01/2008] [Accepted: 07/05/2008] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To investigate the tumor-feeding arteries in hepatocellular carcinoma (HCC) arising in the caudate lobe of the liver. MATERIALS AND METHODS From January 1998 to March 2004, 140 patients with 146 caudate HCCs underwent chemoembolization. Subsegmental location of the caudate HCC and the origin of the tumor-feeding arteries was determined with computed tomography and hepatic arteriography. On follow-up angiography at 6-96 months (mean, 24 months), changes in the tumor-feeding arteries were recorded. RESULTS A total of 175 tumor-feeding arteries were identified. The tumors in the Spiegel lobe (n = 72) were supplied by tumor-feeding arteries derived from the right hepatic artery (RHA; n = 45), left hepatic artery (LHA; n = 30), and proper hepatic artery (PHA) or common hepatic artery (CHA; n = 6; P = .083, right vs left). In tumors in the paracaval portion (n = 42), the tumor-feeding arteries were derived more frequently from the RHA (n = 46) than the LHA (n = 3) or PHA/CHA (n = 2; P < .001). All the feeding arteries (n = 43) of the caudate process tumors (n = 32) were derived from the RHA (P < .001). During the follow-up period, there were replacements of the tumor-feeding arteries in 16 patients with recurrent tumors. An extrahepatic collateral supply for the recurrent tumors developed in 10 patients. CONCLUSIONS The distribution of the origin of tumor-feeding arteries supplying caudate HCC is different according to tumors' subsegmental locations. When treating recurrent caudate HCC, it is important to identify replacement of tumor-feeding arteries and extrahepatic collateral supply.
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Affiliation(s)
- Chang Jin Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
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Chung JW, Kim HC, Yoon JH, Lee HS, Jae HJ, Lee W, Park JH. Transcatheter arterial chemoembolization of hepatocellular carcinoma: prevalence and causative factors of extrahepatic collateral arteries in 479 patients. Korean J Radiol 2007; 7:257-66. [PMID: 17143029 PMCID: PMC2667612 DOI: 10.3348/kjr.2006.7.4.257] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective We wanted to investigate the prevalence and causative factors of extrahepatic arterial blood supply to hepatocellular carcinoma (HCC) at its initial presentation and during chemoembolization. Materials and Methods Between February 1998 and April 2000, consecutive 479 patients with newly diagnosed HCC were prospectively enrolled into this study. A total of 1629 sessions of transcatheter arterial chemoembolization (TACE) were performed in these patients (range: 1-15 sessions; mean: 3.4 sessions) until April 2004. For each TACE procedure, we determined the potential extrahepatic collateral arteries (ExCAs) depending on the location of the tumor, and we performed selective angiography of all suspected collaterals that could supply the tumor. The prevalence of ExCAs and the causative factors were analyzed. Results At initial presentation, 82 (17%) of these 479 patients showed 108 ExCAs supplying tumors. Univariate analysis showed that tumor size (p < 0.01), patient age (p = 0.02), a surface location (p < 0.01), and a bare area location (p < 0.01) were significantly associated with the presence of ExCAs. Multiple logistic regression analysis showed that only tumor size was predictive of ExCA formation (p < 0.01, odds ratio = 1.737, confidence interval: 1.533 to 1.969). During repeated TACE sessions, 97 additional ExCAs were detected in 70 (14%) patients. The cumulative probability of ExCAs in patients with a large tumor (≥ 5 cm) was significantly higher than that for those patients with a small tumor (< 5 cm) (p < 0.01). Conclusion The presence of ExCAs supplying HCC is rather common, and the tumor size is a significant causative factor for the development of these collateral arteries.
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Affiliation(s)
- Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, Chongno-Gu, Seoul, Korea.
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Koizumi J. Arterial Embolization of Unresectable Hepatocellular Carcinoma with Use of Microspheres, Lipiodol, and Cyanoacrylate. Cardiovasc Intervent Radiol 2006; 29:928; author reply 929. [PMID: 16502170 DOI: 10.1007/s00270-005-0231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kim HC, Chung JW, Jae HJ, Lee W, So YH, Park JH. Hepatocellular Carcinoma: Transcatheter Arterial Chemoembolization of the Gonadal Artery. J Vasc Interv Radiol 2006; 17:703-9. [PMID: 16614154 DOI: 10.1097/01.rvi.0000208395.84723.4b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Over the past 9 years, the authors have identified gonadal arteries supplying hepatocellular carcinoma in seven of 4,438 patients (0.16%) whom they attempted to treat by transcatheter arterial chemoembolization. All seven patients had tumors in the Couinaud segment 6 (S6) of the liver (mean size, 6.8 cm). The gonadal arteries in all seven patients showed anatomic variations, including a high origin (n = 3) and a common trunk with the adrenal artery (n = 4). The gonadal artery with anatomic variation may supply hepatocellular carcinomas located in liver S6.
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Affiliation(s)
- Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine, #28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
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Kim HC, Chung JW, Lee W, Jae HJ, Park JH. Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization. Radiographics 2006; 25 Suppl 1:S25-39. [PMID: 16227494 DOI: 10.1148/rg.25si055508] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Extrahepatic collateral arteries commonly supply hepatocellular carcinomas if the tumors are large or peripherally located. Because development of these vessels interferes with effective control of the tumor with transcatheter arterial chemoembolization (TACE), radiologists should become familiar with the imaging findings of extrahepatic collateral vessels to detect them at an early stage. The authors observed 2104 such vessels in 860 patients over 5.5 years. The extrahepatic collateral vessels observed originated from the inferior phrenic artery, omental branch, adrenal artery, intercostal artery, cystic artery, internal mammary artery, renal or renal capsular artery, branch of the superior mesenteric artery, gastric artery, and lumbar artery. The authors suspected extrahepatic collateral vessels when (a) a tumor grew exophytically or invaded adjacent organs, (b) a tumor was in contact with the ligaments and bare area of the liver, (c) a hypertrophied extrahepatic collateral vessel was observed on a computed tomographic (CT) scan, (d) a peripheral defect of iodized oil retention within a tumor was seen during chemoembolization or on a follow-up CT scan, (e) a local recurrence developed at the peripheral portion of the treated tumor during follow-up, or (f) a sustained elevation in serum alpha-fetoprotein level was noted despite adequate embolization of the hepatic artery. When both the hepatic artery and extrahepatic collateral vessels supply a tumor, additional extrahepatic collateral vessel chemoembolization should be attempted to increase the therapeutic efficacy of TACE for hepatocellular carcinoma.
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Affiliation(s)
- Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine, and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
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Suh SH, Won JY, Lee DY, Lee JT, Lee KH. Chemoembolization of the Left Inferior Phrenic Artery in Patients with Hepatocellular Carcinoma: Radiographic Findings and Clinical Outcome. J Vasc Interv Radiol 2005; 16:1741-5. [PMID: 16371544 DOI: 10.1097/01.rvi.0000182172.00168.1b] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to evaluate the radiographic findings of hepatocellular carcinoma (HCC) supplied by the left inferior phrenic artery (LIPA) and the safety and efficacy of transcatheter arterial chemoembolization (TACE) of the LIPA. From September 2002 until August 2004, 11 patients with LIPA supplying HCC were identified and successfully treated with TACE of all LIPAs. LIPA collateral vessels may supply HCC, particularly when the tumors are in the left lobe of the liver in patients who have undergone previous TACE procedures. In this setting, such collateral vessels should be sought on preprocedural imaging. These LIPA collateral vessels may be safely embolized with very good clinical results.
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Affiliation(s)
- Sang Hyun Suh
- Department of Diagnostic Radiology, College of Medicine, Yonsei University, 134 Shinchon-dong, Seodaemoon-gu, Seoul, Republic of Korea 120-752
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Liu DM, Salem R, Bui JT, Courtney A, Barakat O, Sergie Z, Atassi B, Barrett K, Gowland P, Oman B, Lewandowski RJ, Gates VL, Thurston KG, Wong CYO. Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol 2005; 16:911-35. [PMID: 16002500 DOI: 10.1097/01.rvi.0000164324.79242.b2] [Citation(s) in RCA: 202] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The rapid evolution and increasing complexity of liver-directed therapies has forced the medical community to further advance its understanding of hepatic arterial anatomy. The anatomy of the mesenteric system, and particularly the hepatic arterial bed, has been demonstrated to have a high degree of variation. This is important when considering presurgical planning, catheterization, and transarterial hepatic therapies. Although anatomic variants have been well described, the characterization and understanding of regional hepatic perfusion is also required to optimize endovascular therapy and intervention. Although this is true for patients undergoing bland embolization or chemoembolization, drug delivery, and hepatic infusional pump therapy, it is particularly true for intraarterial brachytherapy. The purpose of this review is to provide historical perspective in angiographic aspects of liver-directed therapy, as well as a discussion of normal vascular anatomy, commonly encountered variants, and factors involved in changes to regional perfusion in the presence of liver tumors. Methods of optimizing the safety and efficacy of liver-directed therapies with use of percutaneous techniques will be discussed. This review is based on the experience gained in treating more than 500 patients with transarterial liver-directed therapies. Although the principles described in this article apply to all liver-directed therapies such as chemoembolization and administration of drug-coated microspheres, they apply particularly to intraarterial brachytherapy.
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Affiliation(s)
- David M Liu
- Department of Radiology, Interventional Radiology Section, St. Vincent's Hospital, Portland, Oregon, USA
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Wang YL, Li MH, Cheng YS, Shi HB, Fan HL. Influential factors and formation of extrahepatic collateral artery in unresectable hepatocellular carcinoma. World J Gastroenterol 2005; 11:2637-42. [PMID: 15849825 PMCID: PMC4305757 DOI: 10.3748/wjg.v11.i17.2637] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the influence factors and formation of extrahepatic collateral arteries (ECAs) in unresectable hepatocellular carcinoma (HCC) with or without chemoe-mbolization.
METHODS: Detailed histories of 35 patients with 39 ECAs of HCC and images including computerized tomography scan, digital subtraction angiography were reviewed carefully to identify ECAs of HCC, ECAs arising from, and anatomic location of tumors in liver. Tumor sizes were measured, and relations of ECAs with times of chemoemb-olization, tumor size, and the anatomic tumor location were analyzed. Complications were observed after chemoemb-olization through ECAs of HCC with different techniques.
RESULTS: Influence factors of formation of ECAs of HCC included the times of repeated chemoembolization, the location of tumors in liver, the tumor size and the types of chemoembolization. ECAs in HCC appeared after 3-4 times of chemoembolization (17.9%), but a higher frequency of ECAs occurred after 5-6 times of chemoem-bolization (56.4%). ECAs presented easily in peripheral areas (71.8%) of liver abutting to the anterior, posterior abdominal walls, the top right of diaphragm and right kidney. ECAs also occurred easily after complete obstruction of the trunk arteries supplying HCCs or the branches of proper hepatic arteries. Extrahepatic collaterals of HCC originated from right internal thoracic (mammary) artery (RITA, 5.1%), right intercostal artery (RICA, 7.7%), left gastric artery (LGA, 12.8%), right inferior phrenic artery (RIPA, 38.5%), omental artery (OTA, 2.6%), superior mesenteric artery (SMA, 23.1%), and right adrenal and renal capsule artery (RARCA, 10.3%), respectively. The complications after chemoembolization attributed to no super selective cathet-erization.
CONCLUSION: The formation of ECAs in unresectable HCC is obviously correlated with multiple chemoembolization, tumor size, types of chemoembolization, anatomic location of tumors. Extrahepatic collaterals in HCC are corresponding to the tumor locations in liver.
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Affiliation(s)
- Yong-Li Wang
- Department of Diagnostic and Interventional Radiology, The Affiliated Sixth People's Hospital of Shanghai Jiaotong University, 600 Yi Shan Rd, Shanghai 200233, China.
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Li Z, Hu DY, Chu Q, Wu JH, Gao C, Zhang YQ, Huang YR. Cell apoptosis and regeneration of hepatocellular carcinoma after transarterial chemoembolization. World J Gastroenterol 2004; 10:1876-80. [PMID: 15222027 PMCID: PMC4572221 DOI: 10.3748/wjg.v10.i13.1876] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To evaluate whether cell apoptosis and regeneration were existed in normal liver cells adjacent to carcinoma after transarterial chemoembolization (TACE).
METHODS: Fifty rabbits with hepatic carcinoma were divided into 5 groups at random: group A (control group), groups B and C (TACE treatment groups), groups D and E (partial hepatectomy groups). There were 10 rabbits in each group. Rabbits in groups B-E were treated by transarterial chemoembolization (TACE) and partial hepatectomy (PH) respectively. The changes of S-phase cell fraction (SPF), proliferation index (PI) and cell apoptosis in the normal liver tissue were determined with flow cytometry (FCM) after operations on the first and third days. We determined the mitosis index (MI) with histo-pathological method and the apoptosis index (AI) with TUNEL method at the same time.
RESULTS: Twenty-four hours after operations, compared with control group, the rabbits in TACE group had much higher index of SPF, PI and MI (MI: t = 4.89, P < 0.001; SPF: t = 5.27, P < 0.001; PI: t = 4.87, P < 0.001). Moreover, the proliferation of liver cells in TACE group was much weaker than that of the cells treated by partial hepatectomy, and the differences were significant (MI: t = 7.02, P < 0.001; SPF: t = 4.06, P < 0.001; PI: t = 2.70, P < 0.05). Seventy-two h after operations, FCM showed a small sub-G1 peak in TACE group and PH group, compared with the control group, but there was no difference between them (t = 0.41, P > 0.05). TACE showed that AI in the treated rabbits was higher than that in control group (t = 3.07, P < 0.05), and there were no differences between TACE group and PH group, either (t = 0.93, P > 0.05).
CONCLUSION: Cell apoptosis and regeneration exist in rabbit liver tissues after TACE in some degree, which may be associated with the selective embolization of iodised oil, chemotherapeutic drug and free radical damage.
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Affiliation(s)
- Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.
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Zhao JG, Feng GS, Kong XQ, Li X, Li MH, Cheng YS. Changes of tumor microcirculation after transcatheter arterial chemoembolization: First pass perfusion MR imaging and Chinese ink casting in a rabbit model. World J Gastroenterol 2004; 10:1415-20. [PMID: 15133845 PMCID: PMC4656276 DOI: 10.3748/wjg.v10.i10.1415] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To observe the change of tumor microcirculation after transcatheter arterial chemoembolization (TACE) with bletilla microspheres by using first pass perfusion MR imaging (FP) and Chinese ink casting.
METHODS: VX2 carcinoma cells were surgically implanted into the left and right lobes of liver of 30 New Zealand white rabbits, which were divided into 3 groups at random. Emulsion of lipiodol mixed with mitomycin C, and 5-FU bletilla microspheres were injected into the hepatic artery respectively, and saline was used as control agent. MR imaging was performed with turbo-flash sequence 14 d after tumor implantation and 7 d after interventional therapy. The steepest slopes (SS) of the signal intensity versus time curves were created for quantitative analysis, 7.5% Chinese ink gelatin solution was injected through ascending artery (17 cases) or portal vein (2 cases) for lesion microvessel area (MVA) measurement after the last MRI examination.The correlation between perfusion imaging and MVA was studied blindly.
RESULTS: The SS values at the rim of tumor in lipiodol group (mean, 49% per second) and bletilla group (mean, 35% per second) were significantly decreased (P < 0.05) as compared with control group (mean, 124% per second), no difference was found between lipiodol and bletilla groups (P > 0.05). In lipiodol group, the MVAs (24974 ± 11836 μm2) in the center of the tumor were significantly smaller than those of the control group (35510 ± 15675 μm2) (P < 0.05), while the MVAs (80031 ± 22745 μm2) around the tumor were significantly increased because small and dense plexuses appeared around the tumor which correlated to intense reaction of granulation tissue. None of the vessels was seen in the tumor in bletilla group, the peripheral MVAs of the tumor were significantly smaller than those of the control group (P < 0.05) and lipiodol group (P < 0.05). There was a good correlation between SS and MVAs in control group (rs, 0.985, P < 0.0001) and bletilla group (rs, 0.743, P < 0.05), the correlation was not significant in lipiodol group (rs, 0.527, P > 0.05).
CONCLUSION: TACE with bletilla microspheres may enhance its anti-tumor effect by inhibiting the angiogenesis, and FP-MRI provides useful information to assess the TACE effect by depicting tumor vascularization and perfusion.
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MESH Headings
- Animals
- Carbon/metabolism
- Carcinoma, Hepatocellular/blood supply
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/metabolism
- Carcinoma, Hepatocellular/pathology
- Chemoembolization, Therapeutic/methods
- Contrast Media/therapeutic use
- Diagnostic Imaging
- Female
- Fluorouracil/therapeutic use
- Iodized Oil/therapeutic use
- Liver/cytology
- Liver/metabolism
- Liver/pathology
- Liver Neoplasms, Experimental/blood supply
- Liver Neoplasms, Experimental/drug therapy
- Liver Neoplasms, Experimental/metabolism
- Liver Neoplasms, Experimental/pathology
- Magnetic Resonance Imaging/methods
- Male
- Microcirculation
- Microspheres
- Neoplasm Transplantation
- Neovascularization, Pathologic
- Rabbits
- Random Allocation
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Affiliation(s)
- Jun-Gong Zhao
- Department of Radiology, Sixth Affiliated Hospital of Shanghai Jiaotong University, Shanghai 200233, China.
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Zhao JG, Feng GS, Kong XQ, Li X, Li MH, Cheng YS. Assessment of hepatocellular carcinoma vascularity before and after transcatheter arterial chemoembolization by using first pass perfusion weighted MR imaging. World J Gastroenterol 2004; 10:1152-6. [PMID: 15069716 PMCID: PMC4656351 DOI: 10.3748/wjg.v10.i8.1152] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To assess the vascularity of hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE) with the quantitative parameters obtained by first pass perfusion weighted MR imaging (FP-MRI).
METHODS: Seventeen consecutive patients with one to three lesions in liver underwent FP-MRI before treatment. FP-MRI was also performed one, three, six, nine months, and one year after TACE. The baseline signal intensity (S0) of pre-TACE and one month after TACE was analyzed, the vascularity of HCC assessed by steepest slope of the signal intensity versus time curves (SS) was blindly correlated with their DSA feature and clinical outcome.
RESULT: No significant difference was found on baseline signal intensity (S0) between pre-TACE and one month after TACE (F = 0.309, P = 0.583), The SS (mean, 32% per second) of lesion one month after TACE was lower than that of pre-TACE (mean, 69% per second), but with no statistical significance (F = 3.067, P = 0.092). When local recurrence occurred, the time intensity curves became steeper. The vascularity of HCC before and after TACE graded by SS closely correlated with that by DSA (K = 0.453, P < 0.05).
CONCLUSION: FP-MRI is a useful criterion for selecting effective interventional treatment for patients with HCC in their initial treatment and during follow up.
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Affiliation(s)
- Jun-Gong Zhao
- Department of Radiology, Sixth Affiliated Hospital of Shanghai Jiaotong University, Shanghai 200233, China.
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