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Angiographic subsegmentectomy for the treatment of patients with small hepatocellular carcinoma
Shozo Iwamoto1, Hayato Sanefuji, Kunio Okuda
1Iwamoto Hospital, Kitakyushu, Japan.
Background:
The therapeutic results of nonsurgical treatment for patients with hepatocellular carcinoma (HCC) have been poor, and improved treatments are needed. The authors recently developed a new technique called angiographic subsegmentectomy for the treatment of patients with small HCC.
Methods:
The technique includes confirming the diagnosis of small HCC using a helical computed tomography (CT) scan combined with an angiography system for identifying the tumor-feeding subsegmental hepatic artery, injecting lipiodol containing farmorubicin until it enters the portal vein in sufficient amounts, and injecting sponge particles into the hepatic artery for embolization. Occlusion of the hepatic artery with gel particles and occlusion of the portal vein by lipiodol induce infarction necrosis, which encompasses the entire tumor and the surrounding liver parenchyma.
Results:
The treatment was given to 23 patients with 30 HCC tumors that measured < 20 mm in greatest dimension. It was successful in all 23 patients. Serum alanine aminotransferase levels were elevated to a significant level in the majority of patients after treatment, mild ascites developed in three patients, and the patients complained of pain and fever posttreatment that were controlled readily. No patients developed hepatic failure. Only one patient developed recurrent disease posttreatment at 1.5 years, for a recurrence rate of 5% at 1 year and 6.6% at 1.5 years, a rate that has never been achieved with other treatment modalities.
Conclusions:
Angiographic subsegmentectomy is a novel treatment for patients with small HCC. The results indicated that it is equivalent to undergoing small resection and is superior to conventional arterial chemoembolization.
Insights
Angiographic subsegmentectomy offers a novel, effective treatment for small hepatocellular carcinoma (HCC). This minimally invasive technique achieves superior outcomes compared to conventional methods, with a low recurrence rate.
Area of Science:
- Hepatobiliary Surgery
- Interventional Radiology
- Oncology
Background:
- Nonsurgical treatments for hepatocellular carcinoma (HCC) yield suboptimal results, necessitating innovative therapeutic approaches.
- Hepatocellular carcinoma (HCC) is a prevalent primary liver malignancy requiring effective treatment strategies.
- Small HCC tumors present a therapeutic challenge, driving the development of new interventions.
Purpose of the Study:
- To introduce and evaluate a novel minimally invasive technique, angiographic subsegmentectomy, for treating small hepatocellular carcinoma (HCC).
- To assess the efficacy and safety of angiographic subsegmentectomy in patients with small HCC.
- To compare the outcomes of angiographic subsegmentectomy with existing treatment modalities for small HCC.
Main Methods:
- Diagnosis of small HCC was confirmed using helical computed tomography (CT) scans coupled with angiography.
- The technique involved identifying the tumor-feeding subsegmental hepatic artery, followed by lipiodol and farmorubicin injection, and embolization with sponge particles.
- Hepatic artery and portal vein occlusion were induced using gel particles and lipiodol, respectively, to achieve infarction necrosis of the tumor and surrounding parenchyma.
Main Results:
- Angiographic subsegmentectomy was successfully applied to 23 patients with 30 small HCC tumors (< 20 mm).
- The treatment demonstrated a high success rate with a 1-year recurrence rate of 5% and a 1.5-year rate of 6.6%, significantly lower than other modalities.
- Post-treatment complications included transient elevations in alanine aminotransferase, mild ascites in three patients, and manageable pain and fever; no hepatic failure was observed.
Conclusions:
- Angiographic subsegmentectomy represents a novel and effective treatment option for patients diagnosed with small hepatocellular carcinoma (HCC).
- The study findings suggest that angiographic subsegmentectomy is comparable in efficacy to surgical resection for small HCC.
- Angiographic subsegmentectomy demonstrated superiority over conventional arterial chemoembolization in treating small HCC.