Trans-arterial chemo-emobilization (TACE) combined with laparoscopic portal vein ligation and terminal branches portal vein embolization for hepatocellular carcinoma: a novel conversion strategy

Background: Hepatocellular carcinoma (HCC) is currently one of the most common malignant tumors with the highest mortality rates in the world. Most patients with HCC have lost the opportunity for surgery at the time of initial diagnosis. This study aims to introduce a new conversion strategy: trans-arterial chemo-emobilization (TACE) combined with laparoscopic portal vein ligation (PVL) and terminal branches portal vein embolization (PVE).

Methods: From November 2018 to February 2023, patients with HCC and insufficient future liver remnant (FLR) were included for this novel treatment strategy. At first, TACE was performed. Then, these patients underwent laparoscopic PVL and terminal branches PVE. After hypertrophy of FLR, these patients underwent the second stage of liver resection. All patients were followed up regularly postoperatively.

Results: A total of 13 patients with HCC were included. All patients underwent the TACE and the first stage of laparoscopic PVL and terminal branches PVE. After a mean of 28.7 days after the first stage of operation, the FLR increased by a mean of 183.4 cm³, equivalent to 49%. All patients underwent the second stage of liver resection. There was no surgical mortality. The mean postoperative hospital stay was 9.1 days. The median survival was 24.5 months.

Conclusions: The treatment strategy of preoperative TACE combined with laparoscopic PVL and terminal branches PVE and second stage of liver resection is a preliminarily feasible and relatively safe new strategy which deserves further exploration in the future.