Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Nov 28, 2008; 14(44): 6869-6872
Published online Nov 28, 2008. doi: 10.3748/wjg.14.6869
Complete hepatocellular carcinoma necrosis following sequential porto-arterial embolization
Stéphane Zalinski, Olivier Scatton, Bruto Randone, Olivier Vignaux, Bertrand Dousset
Stéphane Zalinski, Olivier Scatton, Bruto Randone, Bertrand Dousset, Department of Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université Descartes, Paris, France
Olivier Vignaux, Department of Radiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université Descartes, Paris, France
Author contributions: Zalinski S wrote the paper; Scatton O, Randone B and Vignaux O equally contributed to this work; Dousset B participated to the manuscript redaction and to the critical review.
Correspondance to: Bertrand Dousset, Professor, Department of Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université Descartes, 27 rue du Faubourg Saint-Jacques, Paris, Cedex 14, France. bertrand.dousset@cch.aphp.fr
Telephone: +33-1-584117 24 Fax: +33-1-58411645
Received: April 18, 2008
Revised: June 2, 2008
Accepted: June 9, 2008
Published online: November 28, 2008
Abstract

Most patients with hepatocellular carcinoma (HCC) are not eligible for curative treatment, which is resection or transplantation. Two recent series have emphasized the potential benefits of preoperative arterio-portal embolization prior to surgical resection of such tumours. This preoperative strategy offers a better disease free survival rate and a higher rate of total tumor necrosis. In case of non resectable HCC it is now widely accepted that transarterial chemoembolization (TACE) leads to a better survival when compared to conservative treatment. Thus, the question remains whether combined portal vein embolization (PVE) may enhance the proven efficiency of TACE in patients with unresectable HCC. We herein report the case of a 56-year-old cirrhotic woman with a voluminous HCC unsuitable for surgical resection. Yet, complete tumour necrosis and prolonged survival could be achieved after a combined porto-arterial embolization. This case emphasizes the potential synergistic effect of a combined arterio-portal embolization and the hypothetical survival benefit of such a procedure, in selected patients, with HCC not suitable for surgery or local ablative therapy.

Keywords: Hepatocellular carcinoma; Sequential arterio-portal embolization; Palliative treatment