Synchronous Portal Vein Embolization of Terminal Branches with Transcatheter Arterial Chemoembolization Prior to Planned Major Hepatectomy for Hepatitis B Virus-Related Hepatocellular Carcinoma: A Single Center Retrospective Cohort Study.

Background: Terminal branches portal vein embolization (TBPVE) is a novel technical modification. The clinical impact of synchronous TBPVE with transcatheter arterial chemoembolization (TACE) before planned major hepatectomy in hepatitis B virus (HBV) related HCC is still unknown.

Methods: From November 2016 to December 2021, the study enrolled 115 patients with HBV-related HCC who were scheduled for major hepatectomy but had insufficient FLR. Patients were grouped according to whether they received TBPVE combined with TACE (the TBPVE group, n = 62) or PVE combined with TACE (the PVE group, n = 53). We compared the outcomes of the procedures and the perioperative and long-term outcomes of patients who subsequently underwent major hepatectomy between the groups.

Results: FLR volume increment and degree of hypertrophy were significantly higher in the TBPVE group than in the PVE group (P≤0.003). FLR proliferation was pronounced remarkably within the first two weeks after TBPVE synchronous with TACE, the kinetic growth rates were 17.4 (12.7-21.9) mL/day and 6.9 (4.1-11.1) mL/day respectively. 54 patients in the TBPVE group and 41 patients in the PVE group finally underwent major hepatectomies. Pringle's maneuver time, intraoperative blood loss, transfusion, and postoperative hospital stays were less in the TBPVE group (P<0.05). Disease-free survival (DFS) rates were better in the TBPVE group than in the PVE group (P=0.042).

Conclusions: TBPVE synchronous with TACE induced safe and rapid FLR hypertrophy with satisfactory efficacy in initially unresectable HBV-related HCC patients improved the planned major hepatectomy resectability rate and has better DFS.