Hepatocellular Carcinoma Clinical Trial
Official title:
Preoperative Portal Vein Embolization Using Coils Plus TAGM vs Multiple Coils for Patients With Perihilar Cholangiocarcinoma or Hepatocellular Carcinoma: a Randomized Controlled Study
The aim of this study is to investigate the differences of safety and liver hypertrophy between portal vein embolization (PVE) using coils plus tris-acryl gelatin microspheres (TAGM) and multiple coils in patients with perihilar cholangiocarcinoma (pCCA) or with hepatocellular carcinoma (HCC).
Perihilar cholangiocarcinoma (pCCA) and hepatocellular carcinoma (HCC) both are common
primary hepatobiliary tumors, which often require extensive hepatic resection and challenge
perioperative management as surgery remains the only chance of long-term survival for such
patients. PVE induces effective hypertrophy on one side of the liver parenchyma ahead of a
planned liver resection of the other side which becomes atrophic.
Technically, the percutaneous transhepatic approach becomes the standard of care for PVE.
PVEs themselves with different embolization materials could vary in the degree of liver
hypertrophy, though some techniques, such as TAE, HVE and stem cell, have been already used
in combination with PVE and could promote the hypertrophy. Several aspects on the use of PVE
are insufficiently studied and most recommendations are based on low-grade evidence. Large
clinical studies that compare the effect of different embolic materials on the hypertrophy
response are lacking. PVE using multiple coils to completely occlude all the target segmental
and sectional branches is a conventional and fundamental approach in our center, which
ensured a reliable hypertrophy response with a low PVE-related morbidity and post-hepatectomy
liver failure rate in the past decades. PVE using with tris-acryl gelatin microspheres (TAGM)
distally and coils proximally, which needs more interventional experience, has become one of
standard approaches in our center. However, the study of high-grade evidence regarding the
hypertrophy effect of PVE with TAGM and coils is still lacking.
In this randomized study, the investigators aim to compare PVE using TAGM plus coils to PVE
using coils alone, in term of PVE-related complications, hypertrophy degree, hepatectomy
completion rate, post-hepatectomy liver failure rate, features of immunohistochemical
examination on parenchyma, for patients stratified by either pCCA or HCC.
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