TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA BEFORE ORTOTHOPIC LIVER TRANSPLANTATION
EDİP AKPINAR, HENRI BISMUTH, RENE ADAM, MICHEAL REYNES, DENIS CASTAING
Hepato Biliyer Cerrahi Merkezi, Villejuif-FRANSA
Transcatheter arterial hepatic chemoembolization (TAE) for hepatocellular carcinoma (HCC) have been described either as a palliative approach or as an adjunct approach before surgery. Besides the promising results which have been reported with this treatment with respect to survival and life quality, its benefit/risk ratio remained controversial. This study aims to analyse 65 cirrhotic patients with HCC who were transplanfed orthotopically after TAE cures, Operative mortality was 1.5%. Twenty one patients (33%) were recurred in 24.4 months (2-116) of follow up period. In a group of 15 patients (24%) with complete tumoral necrosis after TAE, the recurrence rate was zero. Portal thrombosis, capsular invasion, satellites, venous extension, the abscence of the capsule, multiple nodules and large diameters were found as risk factors for recurrence in univariate analysis. Whereas, in multivariate analysis, the diffuse-infiltrative tumors, the in-completeness of the capsule and the tumoral extension to adjacent tissues were found as the best predictive independent risk factors for recurrence. A complete tumoral necrosis was obtained by TAE correlates with a remarkably better disease free survival after hepatic transplantation than the group with incompete necrosis.
Keywords: HEPATOCELLULAR CACINOMA, TRANSCATHETER HEPATIC ARTERIAL CHEMOEMBOLIZATION, ORTHOPOTIC LIVER TRANSPLANTATION