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Radical resection after tumour-downstaging with transcatheter arterial chemoembolization for unresectable primary liver cancer / 中华肝胆外科杂志
Chinese Journal of Hepatobiliary Surgery ; (12): 361-364, 2012.
Article in Chinese | WPRIM | ID: wpr-425647
ABSTRACT
ObjectiveTo study the proper timing for radical hepatectomy after tumour-down-staging with transcatheter arterial chemoembolization for unresectable primary liver cancer.Method This is a retrospective study of 18 patients with unresectable primary liver cancer who received radical liver resection after tumour-downstaging with transcatheter arterial chemoembolization (TACE) from January 2005 to August 2010 at Zhejiang Province People's Hospital Hepatobiliary Surgery Department.The patients received TACE 1 to 3 times (once n=4,twice n=12,and thrice n=2).After tumour-downstaging,radical liver resection was carried out (right hepatectomy,n =10 ; resection of tumour in right liver + resection of right liver metastases,n=2; resection of tumnour in right liver +radiofrequency ablation of right liver metastasis,n=1; right hepatectomy + removal of portal vein tumour thrombus,n=1 ; left hepatectomy + radiofrequency ablation of right liver metastases,n=2 ;Mesohepatectomy,n=1; and left hepatectomy + excision of liver metastasis,n=1).ResultsAfter TACE,the diameter of the primary tumour reduced by over 30% in 6 patients (6/18,33.3%);10%~30% in 8 patients (8/18,44.4%),and 10% in 4 patients (4/18,22.2%).Before TACE,the tumours were not encapsulated in 6 patients (33.3%).After TACE,only 1 patient (5.6%) had the tumour remained unencapsulated.After TACE in 6 patients,the primary tumour shrunk to be within a hemiliver,and ultrasound and CT showed the tumours to have defined borders and they were away from the porta hepatis and major blood vessels.In another 6 patients,there were metastases to the contralateral hemilivers but these tumours had all shrunk in size.Selective vascular inflow and outflow occlusion technique was routinely used for liver resection.ConclusionFor primary liver cancers which are not resectable,TACE should be used first.When the tumours shrink in size,radical resectional surgery should be performed as soon as possible.The surgical technique should follow the following principles-preserve as much normal liver parenchyma as possible,use selective vascular inflow and outflow occlusion technique to avoid ischaemia/reperfusion injury to the remnant liver,and to reduce haemorrhage.The surgery should be carried out by experienced surgeon.

Full text: Available Index: WPRIM (Western Pacific) Type of study: Observational study Language: Chinese Journal: Chinese Journal of Hepatobiliary Surgery Year: 2012 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Type of study: Observational study Language: Chinese Journal: Chinese Journal of Hepatobiliary Surgery Year: 2012 Type: Article