Super selective TACE for Hepatocellular carcinoma

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　ガンちゃん先生が行っている肝臓がんの治療を
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Hi！ I’m Dr. Ganchan.

Today, I would like to introduce my treatment using a catheter device for liver cancer, especially hepatocellular carcinoma (HCC).

This patient had three small HCCs.
Since this patient is high age, hepatic resection is not selected. Then, I treated these HCCs with transcatheter arterial chemoembolization, named TACE.

In my clinic (Iwamoto Internal Medicine Clinic), I use angio-CT system to perform TACE.

After an angiography from a celiac artery (figure), I insert a 1.7 Fr micro catheter into hepatic arteries. And I detect tumor feeding arteries using angio-CT (fiigure).

After detection of tumor feeding artery, I carefully insert the microcatheter into the tumor feeding artery (sub-/sub-/sub- hepatic segment level/ figure).

After insertion of the microcatheter, I inject a chemo-lipiodol emulsion and an embolic agent up to visualize a peripheral branch of the portal vein related with the tumor located segment.

As you can see in the Figure, the injected lipiodol (drug) only pooled in tumor, not in peripheral liver. To do so, we can treat HCCs with high-efficacy and without excessive damage to the liver.

What I want to say is that TACE procedure is very subjective and depends on the operator’s technique and thought. Where (which artery) is the drug administered from?/ When do you stop injection of the drug? There are no objective criteria, which might cause dispersion of the results.

To reduce these issues, I recommend to use angio-CT. By using angio-CT, we can detect tumor feeding artery objectively. And visualization of peripheral branches of the portal vein related with tumor located area is very good criteria to suggest an end-point of administration of the drug. My father (the previous director of Iwamoto Internal Medicine clinic) named such a super selective TACE “angiographic sub-segmentectomy”.

Of course, we cannot treat all HCCs using angiographic sub-segmentectomy and there is no guarantee that every treatment will go accordingly. There are many hard-to-treat cases. However, refinement of the procedure is very important and improvement of the technique is essential for TACE procedure.
This is a road to be a master angiography!

Thanks!

肝臓がん、転移性肝がんでお困りの方は、いつでも、どんな状態でも一度、岩本内科医院にお問い合わせください。
Source: ガンちゃん先生奮闘記