Selective portal vein embolization combined with transcatheter arterial chemoembolization for the treatment of hepatic metastatic carcinomas: a control study

Objective To discuss the therapeutic effect and the safety of selective portal vein embolization(PVE) combined with transcatheter arterial chemoembolization(TACE) in the treatment of hepatic metastatic carcinomas.Methods A total of 49 patients with hepatic metastatic carcinomas,who were unable to undergo or refused to receive surgical resection of liver,were enrolled in this study.The patients were divided into control group(n = 26) and study group(n = 23).Only TACE was performed in the patients of the control group,while PVE together with TACE was carried out in the patients of the study group.After the treatment,the liver function,liver volume,untoward effects,postoperative complications,the short-term curative effects and cumulative survival rates of both groups were determined,and the results were compared between the two groups.Results(1) Six months after the treatment the effective rate of the study group was 65.2%(15/23),which was significantly higher than that of the control group(30.8%,8/26) with P = 0.04.In the study group,the longest diameter of the tumor decreased from preoperative(9.92 ± 2.63) cm to postoperative(7.32 ± 2.61)cm.In the control group the longest diameter of the tumor decreased from preoperative(10.34 ± 3.12)cm to postoperative(9.13 ± 3.42)cm.The results of the study group was superior to that of the control group(P = 0.04).The median survival time of the study group and the control group was 21 months and 13 months,respectively.Significant difference in cumulative survival rate existed between the two groups(P 0.05).(2) After the treatment,no obvious change in liver volume was seen in the control group.In the study group,the preoperative volume of non-embolized liver lobe was(481 ± 2 51)cm3,which enlarged to(523 ± 250)cm3,(548 ± 249)cm3 and(552 ± 249)cm3 at two,four and eight weeks after the treatment,respectively.And the percentage of these increases was(10.1 ± 7.6)%,(16.1 ± 10.9)% and(17.2 ± 11.5)%,respectively.(3) After the treatment,no obvious change in serum albumin level was found in both groups.In the study group the ALT,AST and TB levels were markedly elevated at the first and third day after the operation,then they dropped at the seventh day(P 0.05).The ALT,AST and TB levels in the study group at the first and third day after the operation were higher than those in the control group.But the differences in the ALT,AST and TB levels at the seventh and fourteenth day between the two groups were of no significance.Conclusion Selective portal vein embolization combined with transcatheter arterial chemoembolization can effectively control and reduce the hepatic metastatic carcinomas,improve the patient's cumulative survival rate.Therefore,this combination use of PVE and TACE is a safe and effective treatment for inoperable hepatic metastatic carcinomas.