Efficacy and safety of preoperative lobar or segmental ablation via transarterial administration of ethiodol and ethanol mixture for treatment of hepatocellular carcinoma: Clinical study

Transarterial embolization (TAE) using various thrombotic substances for un resectable hepatocellular carcinoma (HCC) performed on many patients has re sulted in a better survival rate. We evaluated the efficacy and clinical sa fety of using an Ethiodol-ethanol mixture as the embolizer for treatment of HCC and the possibility of a surgical approach for inoperable tumors after TAE, Twenty patients with HCC who underwent TAE and tumor resection were i ncluded in the study. Initially, eight had increased retention rate of indo cyanine green dye via intravenous injection (0.5 mg/kg) at 15 minutes (ICGR 15), and six had an insufficient residual volume that precluded them from u ndergoing tumor resection. TAE was performed by slowly infusing the mixture of Ethiodol and ethanol into the artery supplying the tumor until dual hep atic artery and portal vein embolization was achieved. Serum levels of alan ine amino-transferase increased after embolization, but all biochemistry st udies reverted to normal within 2 weeks. A decreased tumor size (n = 15), i mproved ICG (n = 8), and increased volume of the nonembolized lobe (n = 10) were noted. The operations performed were right lobectomy (n = Ii), extend ed right lobectomy (n = 3), left lobectomy (n = 2), extended left lobectomy (n = 2), and wedge resection (n = 2), which included patients who did not want to undergo major hepatectomy. Complete tumor necrosis,vas found in sev en cases. All patients survived with no associated complications. The I-gea r survival rate was 95%. Transarterial Ethiodol and ethanol administration creating dual hepatic artery and portal vein embolization was a safe and ef ficacious method far treating HCC it effectively decreases tumor size, caus es compensatory hepatic hypertrophy, and improves the ICCR15, which allows a wider range of patients to undergo liver surgery and achieve better survi val.