Comparing Preoperative Strategies for Increasing Resectability in HCC

In a recent systemic review and meta-analysis, researchers found that preoperative strategies are able to effectively increase resectability rates for patients with hepatocellular carcinoma (HCC).

The investigators searched PubMed, EMBASE, Cochrane and Scielo/LILACS for studies that included certain procedures— portal vein embolization or ligation (PVE/PVL), sequential transarterial embolization and PVE (TACE + PVE), and radioembolization (RE) and associated liver partition and portal vein ligation for staged hepatectomy (ALPPS). Outcomes such as perioperative morbidity and mortality, post-hepatectomy liver failure (PHLF), and survival rates were analyzed.

In all, there were 46 studies comprising 1,284 patients that were eligible for the review. Analysis revealed that patients receiving TACE + PVE had higher resection rates (90%) than those receiving PVE/PVL (75%). In fact, the resection rate for TACE + PVE was similar to that of ALPPS (84%).

However, a comparison of ALPPS to PVE/PVL and TACE + PVE showed that ALPPS was linked with higher PHLF and perioperative mortality rates. Additionally, there was a higher risk of serious complications with ALPPS and RE than with PVE/PVL and TACE + PVE.

The authors summarized their conclusions by stating that “preoperative strategies to increase liver volume are effective in achieving resectability of HCC.” They added, “TACE + PVE is as safe as PVL/PVE providing higher OS. ALPPS is associated with a higher risk of PHLF, major complications, and mortality. RE despite the small experience seems to present similar resection rate and OS as TACE + PVE with higher rate of major complications.”

Reference

Tustumi F, Ernani L, Coelho FF, et al. Preoperative strategies to improve resectability for hepatocellular carcinoma: a systematic review and meta-analysis.

HPB (Oxford). 2018 Jul 26. pii: S1365-182X(18)32648-0. doi: 10.1016/j.hpb.2018.06.1798. [Epub ahead of print].