Drug & Device Development

Angiographic subsegmentectomy safe and effective for small liver tumors

Last Updated: 2009-12-24 10:45:28 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Angiographic subsegmentectomy yields "excellent" outcomes when used to treat stage I and II hepatocellular carcinoma (HCC), Japanese investigators report in an online issue of the journal Cancer.

Angiographic computed tomography has allowed doctors to localize and characterize HCC more precisely, the investigators note. To perform the angiographic subsegmentectomy, doctors simultaneously embolize the peripheral feeding arteries of the tumor and the peripheral portal veins of the same portion of the liver, using small particles of a gelatin sponge impregnated with mitomycin C mixed in iohexol. Multiple HCCs can be treated at the same time.

Afterward, the HCC and surrounding liver parenchyma become necrotic and surgeons remove it, lead author Dr. Shozo Iwamoto, from Iwamoto Hospital in Kitakyushu, and associates explain.

They note that massive ascites, icterus, and renal failure are contraindications to the procedure.

Follow-up ranged from 0.5 to 8 years. There were 4 recurrences among 41 cases of solitary HCC < 3 cm. Four of eight larger tumors returned.

Among 120 total patients reviewed, survival rates at 5 years were 74% for stage I and 66% for stage II; rates at 8 years were 53% and 40%, respectively. Five- and 8-year survival was 47% and 17% for stage III tumors.

The authors observed no statistically significant differences in survival rates between stage I and II tumors and those of Child-Pugh grade A and B.

There were no severe complications or treatment-related deaths, although alanine aminotransferase levels tended to rise higher than with conventional transcatheter arterial chemoembolization. The physicians treated cases of ascites or pleural effusions with diuretics and albumin.

Thus, Dr. Iwamoto's team writes, angiographic subsegmentectomy is a safe and effective treatment method for HCC. However, it should be done with care.

"To perform angiographic subsegmentectomy successfully requires skill and the careful monitoring of patients to prevent spasm of the arterioles or backflow of the embolus," they caution. Careful attention to liver function is particularly important for larger HCCs or those at the liver hilum.

They conclude: "Angiographic subsegmentectomy should be investigated further as potential first-line therapy for the treatment of patients with stage I and II HCC."

Cancer 2009.