What is the best way to treat liver cancer patients? Liver cancer patients can choose interventional treatment methods

There are many methods for treating liver cancer. How do liver cancer patients and their families choose the appropriate treatment method? Simply put, the treatment method of liver cancer is mainly determined by the stage of the tumor and the patient's condition. For early liver cancer less than 3cm, surgical resection and local interventional ablation are equally effective. Therefore, surgical resection and radiofrequency/microwave/cryoablation are both optional treatment methods. For single nodule tumors of 3-5cm in size, surgical resection and local ablation are equally effective. For large liver cancers larger than 5cm, surgical resection and interventional treatment (TACE) can be selected. TACE should be selected if the tumor volume exceeds 50% of the liver volume, the tumor is diffusely distributed, exceeds 2/3 of the normal liver range, or the tumor infiltrates the surrounding large blood vessels such as the inferior vena cava.

For patients with advanced liver cancer, whose general condition is extremely poor and who cannot tolerate surgery or interventional treatment, symptomatic supportive treatment is the main treatment, supplemented by biological and immunotherapy.

Interventional treatment options for liver cancer patients before surgery: portal vein embolization

Liver cancer is one of the most common malignant tumors in my country. Although there are many treatment methods, liver resection is still the first choice and the most effective method for treating liver tumors. However, when the remaining liver tissue after surgery cannot meet the needs of the body, the patient will suffer from postoperative liver failure, and the patient's postoperative mortality rate will increase successively. The general indicator is: if the liver function is normal, at least 25% of the liver should be left after surgery. If the liver function is abnormal, at least 40% of the liver should be left after surgery. Portal vein embolization (pVE) mainly embolizes the portal vein of the resected liver lobe, thereby causing the remaining liver lobe to proliferate. After liver lobectomy, because more liver tissue is retained, postoperative recovery will be better, and liver cancer patients who cannot be directly surgically removed will have the opportunity for surgical resection.

Before embolization, basic blood tests are usually performed to measure blood coagulation and liver function, and CT scans are performed to develop a plan for liver lobectomy and measure the volume of the remaining liver lobe in the future. During the operation, under local anesthesia and using ultrasound guidance, the doctor will use a fine needle to puncture a portal vein tributary, then insert the vascular sheath, introduce the catheter, and inject contrast agent to visualize the entire portal vein. Some patients will feel a warm sensation after the contrast agent is injected. Based on the results of the angiography, the doctor selects the portal vein tributary to be embolized and injects the embolic material. The application of embolic materials varies from hospital to hospital. In Europe and the United States, tiny particles and metal spring coils are generally used. In less developed countries, NBCA glue embolic agents and iodized oil, fibrin microparticles, gelatin sponge particles, etc. may be included. After the operation, another angiography is performed to ensure that there is no portal vein blood flow on the embolized side, and the portal vein blood flow on the retained side is normal. The operation is ended and all equipment is removed. The entire operation takes about 1 to 3 hours depending on the complexity of the disease. In general, the patient's physiological indicators such as blood pressure, pulse, blood oxygen level, etc. will remain stable, and the patient will not feel severe discomfort and pain. Some patients will have post-embolism syndrome, including abdominal pain, bloating, vomiting, fatigue and mild fever. This syndrome usually disappears within a few days. One month later, the patient will undergo another CT scan to determine the extent of liver lobe enlargement.

However, pVE embolization is not effective for every patient or does not result in adequate liver lobe hyperplasia. It should be used with caution or prohibited in patients with severe portal hypertension, tumor invasion into the preserved liver tissue or extrahepatic tumor metastasis, uncorrectable coagulation disorders, tumor invasion into the portal vein, no safe puncture route due to tumor invasion, and renal failure.

In conclusion, preoperative pVE can increase the volume and function of the remaining liver tissue and expand the indications for surgery. Preoperative pVE can make the perioperative complications and long-term survival rate of appropriately selected patients reach or approach those of patients with liver tumors that can be directly resected.