Interventional therapy is currently an internationally recognized effective method for inoperable advanced hepatocellular carcinoma, and the most common interventional procedure is hepatic artery embolization chemotherapy (TACE).
I. What is TACE?
Hepatic artery embolization chemotherapy, abbreviated as TACE, has been very mature since it was carried out in China in the 1980s and is basically synchronized with foreign countries. Through this technique, doctors can use X-ray and other equipment, just like having a “fluoroscopic eye”, to introduce a thin catheter into the tumor blood vessels and directly infuse chemotherapeutic drugs into the tumor, so that there is a high concentration of drugs in the tumor. Based on this, embolic agent can be injected through catheter to block tumor blood vessels and cut off tumor’s nutrition source to “starve” the tumor.
Process and principle of hepatocellular carcinoma interventional therapy
The method of hepatic artery chemoembolization is to percutaneously puncture the femoral artery at the root of the thigh, insert a tube to the tumor artery of the liver, and then administer a certain dose of chemotherapeutic drugs through the catheter, which can increase the local drug concentration of hepatocellular carcinoma and achieve the purpose of improving the efficacy and reducing side effects.
Since 90%-95% of the blood supply of primary hepatocellular carcinoma comes from the hepatic artery, the chemotherapeutic drugs are mainly concentrated in the hepatocellular carcinoma area with arterial blood supply, while less damage is done to the normal liver tissue which mainly relies on portal vein blood supply. The concentration of drugs in the liver is 100-400 times higher than that in the whole body after treatment, and the efficacy of killing cancer cells is 10-100 times higher. Meanwhile, some solid or liquid substance can be selectively injected into and embolized the blood vessels of liver cancer through catheter to block the blood supply of tumor and inhibit the growth of tumor.
III. What kind of liver cancer patients are suitable for interventional therapy
Suitable groups.
1.Primary or metastatic liver cancer that cannot be surgically resected, or small liver cancer that the patient does not want to operate;.
2, preoperative embolization chemotherapy, which can reduce the size of tumor or reduce intraoperative bleeding of hepatocellular carcinoma.
3, patients whose hepatocellular carcinoma was not completely resected, recurred after surgery or failed to be treated by other methods
4.Patients whose liver cancer lesions rupture and bleed or have obvious pain and are inoperable
5.Patients without serious jaundice and ascites, without serious bleeding disorders and with good general condition of the patient.
6.Preventive consolidation treatment after hepatocellular carcinoma resection.
Unsuitable population (relative).
Those with poor liver function and systemic conditions that cannot tolerate surgery.
IV. How much interventional treatment costs and how many courses are needed
The cost of comprehensive interventional treatment, without special circumstances, is generally about 15,000 to 20,000 yuan per operation + hospitalization. Generally 2-3 courses of treatment. Each time the interval is about 2 and a half months.
V. What are the advantages and efficacy compared to traditional surgery?
Advantages.
1.Effective: AFP decreases rapidly, lump shrinks, pain is reduced, etc.
The operation is simple and easy, safe and reliable, local anesthesia replaces general anesthesia, and can be performed for the elderly, frail and those with certain chronic diseases, and the whole operation is always awake.
3.The cost is relatively low compared with surgical operation.
4.It can be repeatedly performed, and the diagnostic imaging is clear and easy to compare.
5.For some hepatocellular carcinoma, it can be reduced in size and then resected in two steps.
Curative effect.
The one-year survival rate is about 65%, the highest reported three-year survival rate is 43.5%, and the five-year survival rate is 21.2%. In addition, most of the patients can be treated by interventional therapy to shrink the tumor and get the chance of surgery to get a longer survival time.
What are the postoperative sequelae or complications?
1. nausea and vomiting, loss of appetite: the toxic side effects of chemotherapy drugs.
2, epigastric pain: after TACE treatment, the pain can be relieved after 2-5 days. Postoperative analgesic treatment can be given when necessary.
3. Fever: it is the absorption fever caused by tumor tissue necrosis, and the body temperature can be increased on the 2nd day after surgery, generally 37.5-39℃.
4. Hematoma at the puncture site: as long as keep lying down and lower limbs straight for 24 hours. Hematoma is mainly due to activity.
5. Chemotherapy causes a short-term decrease in red blood cell, white blood cell and platelet counts.
7.Does taking radiation during surgery affect human body greatly?
Some studies have shown that the average X-ray radiation dose received for one liver cancer interventional surgery is equivalent to 100 abdominal plain films. Although rays can cause some potential damage to human body, therefore, weighing the pros and cons, liver cancer interventional treatment can obtain valuable therapeutic effect with minimal cost and radiation, and the pros outweigh the cons.
VIII. How often should we have regular review after surgery and what items should be reviewed?
The main items of each review include upper abdominal CT, blood routine, liver function, AFP concentration, etc. Generally, it is necessary to review before the next intervention, and if necessary, blood test is sometimes necessary in about one month.
Can interventional treatment for liver cancer replace surgical treatment?
For liver cancer, interventional therapy and surgery are complementary. For early stage liver cancer, surgical resection is still the first choice, and early resection is the key to improve survival rate, and the smaller the tumor, the higher the five-year survival rate. However, for advanced hepatocellular carcinoma, patients basically have no chance of surgery, and interventional treatment becomes the first choice. At the same time, interventional treatment before and after surgery is more helpful to reduce the recurrence rate of tumor and prolong the survival time of patients.
X. What is the approximate length of hospital stay and operation time for one interventional procedure? What should I pay attention to after surgery?
The whole operation time, including preoperative preparation, sterilization, operation and hemostasis, is about 1-2 hours.
The hospital stay is 3-7 days to regulate the side effects and complications, and you can be discharged after basic stabilization, and the total hospital stay is about 1 week.
Precautions.
(a) Patients should practice bed rest for 1-2 days before surgery to relieve bowel movements and urination.
After surgery, the patient should enhance nutrition and have a reasonable diet, which should be rich and balanced, rich in high-quality protein and vitamins, and light and easy to digest.