ABSTRACT
Major hepatectomy for large HCC in patients remains a crucial procedure due to the possibility of a low regeneration of the future liver remnant (FLR). It has been demonstrated that preoperative portal vein embolization (PVE) increase the tolerance of right hepatectomy. Selective transcatheter arterial chemoembolization (TACE) before PVE could improve the rate of hypertrophy of the FLR in patients with chronic liver disease. In this chapter we show the efficacy and the long term effect of this double preparation before a major hepatectomy. TACE, 3-4 weeks before PVE is well tolerated and increased significantly the FLR as compared to PVE alone. Preoperative, sequential TACE and PVE increase the FLR and provide a high rate of complete tumor necrosis which was associated with good disease free survival. We advocate this double preoperative radiological procedure in cirrhotic patients with HCC requiring major hepatectomy.
