Reductive surgery plus percutaneous isolated hepatic perfusion for multiple advanced hepatocellular carcinoma

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Interventional Radiology

Background:

• Surgical resection is the primary treatment for hepatocellular carcinoma (HCC), but many advanced cases are unresectable.
• Percutaneous isolated hepatic perfusion (PIHP) offers a minimally invasive approach for high-dose regional liver chemotherapy.
• Previous phase II studies demonstrated PIHP's significant efficacy in controlling advanced HCC locally.

Purpose of the Study:

• To assess the effectiveness of a novel two-stage treatment strategy.
• The strategy combines reductive surgery with percutaneous isolated hepatic perfusion (PIHP).
• The treatment targets multiple, previously unresectable hepatocellular carcinoma (HCC) cases.

Main Methods:

• A prospective study enrolled 25 patients with multiple advanced HCC.
• The first stage involved reductive hepatectomy (major hepatectomy or segmentectomy/less), with lymph node resection in 2 patients.
• The second stage consisted of PIHP with doxorubicin (60-120 mg/m2/treatment) administered 1-3 months post-surgery, following routine cholecystectomy and arterial ligations to enhance safety and efficacy.

Main Results:

• Twenty-two of 25 patients successfully completed PIHP (average 1.8 sessions).
• In the 22 patients receiving the two-stage treatment, 86% achieved objective local tumor control (10 complete remissions, 9 partial responses).
• The 5-year actuarial survival rate for all 25 patients was 42%.

Conclusions:

• The combination of reductive surgery and PIHP demonstrates a potent antitumoral effect on multiple advanced HCC.
• This approach offers long-term survival for select patients with previously unresectable disease.
• Successful application is contingent on adequate patient liver function to tolerate the concentrated treatment.