Introduction: Portal vein embolization (PVE) provokes tumor progression. LC decreases FLR regeneration capacity doubling the risk for patient dropout. Our aim was to develop method of FLR augmentation that convert aggressive tumor into safe vaccine and prolonged waiting period for FLR regeneration into effective In situ immunization period. Methods: 3 initially unresectable patients due to small FLR with advanced hepatocellular carcinoma (HCC) and LC were treated. Selective transarterial chemoembolization with short term biodegradable starch microspheres (DSM-TACE), into tumor bearing liver to be resected, was followed by simultaneous PVE of latter. Upon completion of PVE selective intratumoral immunotherapy (HIT-IT) with antiPD-L1 (atezolizumab 1,200 mg) into restored after DSM-TACE tumor arterial feeders (for selective connection with PD-L1 ligands located on tumor cells but not on normal human tissues) was done. DSM-TACE and HIT-IT was repeated one more time in all patients after postzenith decrease of T-cytotoxic cells. Results: Predominantly T and NK cells response was observed. All patients had successfully underwent major liver resection upon sufficient FLR regeneration. In all 3 cases we had achieved effective local tumor control via total or subtotal HCC necrosis, even more, in 1 (33%) case planned amount of liver resection was decreased due to achieved tumor downsizing. There were no severe morbidity or Immune-related adverse events (irAEs). Conclusions: Herein we had proposed new aggressive but safe method of FLR augmentation for patients with HCC and LC that could potentially preclude drop out of patients during anticipated prolonged waiting period of FLR augmentation and possible improves long-term outcomes by means of tumor downsizing and HCC immunoscore conversion.

Introduction: Portal Vein Embolization (PVE) is gold standard strategy to increase Future Liver Remnant (FLR) at level of Kinetic Growth Rate (KGR) about 2.3 cc/day and prevent posthepatectomy liver failure (PHLF) in patients to underwent major liver resections. Up to 30% of patients with liver malignances still couldn't underwent surgery after PVE due to tumor progression and/or insufficient FLR regeneration during waiting period. Currently there are no methods that resolve both mentioned issues. Method: Six initially unresectable, due to small FLR, patients with colorectal liver metastases (CRLM), in close proximity to FLR critical structures (portal and/or hepatocaval confluence), having more than three criteria of Fong Clinical Risk Score for CRLM were approved by Ethical Comitee for Simultaneous PVE and Transarterial Chemoembolization with Degradable Starch Microspheres (DSM-TACE). For those patients, SIMULTA-NEOUSLY with standard PVE, was performed

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Introduction: Portal vein embolization (PVE) is gold standard strategy to increase future liver remnant (FLR). Up to 30% of patient with liver malignance still couldn't underwent surgery after PVE due to tumor progression and/or insufficient FLR regeneration during waiting period. Methods: Nine patients with colorectal liver metastases (CRLM) and small FLR, in close proximity to FLR critical structures (portal and/or hepatocaval confluence), having more than three criteria of Fong Clinical Risk Score for CRLM were approved by Ethical Committee for Simultaneous PVE and Transarterial Chemoembolization with Degradable Starch Microspheres (DSM-TACE). For those patients, standard PVE was simultaneously followed by oxaliplatin based DSM-TACE with short-term embolic material of the whole tumor bearing liver to be resected that allowed to achieve both tumor control and postembolic infarction in liver to be removed, as a trigger of increased FLR regeneration, without biliary tree damage. Results were compared with 23 patients in control group after standard PVE. Results: Unprecedented FLR regeneration with kinetic growth rate 23.5 cc/day (range from 17.6 to 57.25 cc/day) was observed enabling extended hepatectomies within 2 weeks compared with 5 weeks waiting period in control group. In all CRLM about 60% (range from 40% to 90%) necrosis was achieved. There was no severe morbidity (including posthepatectomy liver failure) and mortality. Conclusions: We propose method of preoperative FLR adaptation which is not only second to none in the achieving liver regeneration rate but also is the only one that allows tumor control targeting both main reasons for patient dropout during waiting period for FLR regeneration.