Selective Chemoembolization of Caudate Lobe Hepatocellular Carcinoma: Anatomy and Procedural Techniques

Abstract

Transarterial chemoembolization is the most common treatment for unresectable hepatocellular carcinomas (HCCs). However, when an HCC is located in the caudate lobe, many interventional radiologists are reluctant to perform chemoembolization and percutaneous ablation owing to the tumor's complex vascular supply and deep location. With the advent of C-arm CT, rendering the three-dimensional display of the hepatic artery and detecting the tumor-feeding vessels are possible and can help guide interventional radiologists to the tumor. The common origins of the caudate artery include the right hepatic artery, left hepatic artery, right anterior hepatic artery, and right posterior hepatic artery. The origins of the tumor-feeding arteries of a caudate lobe HCC can vary depending on the tumor's subsegmental location. Caudate lobe HCCs are commonly fed by multiple caudate arteries that are connected. In addition, extrahepatic collateral arteries frequently supply recurrent tumors in the caudate lobe. The caudate artery can supply portal vein thrombi or biliary tumor thrombi in patients with HCC. Several techniques such as preshaping the microcatheter or using the shepherd's hook technique are needed to catheterize the caudate artery in complex cases. Although uncommon, bile duct stricture is a serious complication following selective chemoembolization through the caudate artery. Identification and catheterization of the caudate artery have become possible in most patients by using C-arm CT and a fine microcatheter system, respectively. The authors review the anatomy of the caudate artery with C-arm CT and describe basic technical considerations in selective chemoembolization for caudate lobe HCCs. Unusual circumstances that require catheterization and techniques used for catheterizing the caudate artery are also described.

Effectiveness of Transarterial Chemoembolization-First Treatment for Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis

“…The caudate artery was selectively treated because major PVTT is commonly supplied by the caudate artery. 19 An emulsion of iodized oil (2–12 mL) and doxorubicin hydrochloride (10–60 mg) was infused into the tumor feeding artery until dense accumulation of iodized oil in the tumor was noted on fluoroscopy. The amount of emulsion administered was selected based on the tumor burden in each tumor-feeding artery.…”

Caudate Lobe Hepatocellular Carcinoma Treated with Sequential Transarterial Chemoembolization and Iodine 125 Seeds Implantation: A Single-Center Retrospective Study

“…2,3 Cases of HCC originating in the caudate lobe (HCC-CL) are rare, with an incidence rate between 1.9% and 12.4%. [4][5][6][7] The implementation of surveillance programs for high-risk populations and advances in diagnostic imaging technology has increased the diagnosis rate of HCC-CL. 8,9 The surgical resection and percutaneous radiofrequency ablation (RFA) can be used as a curative treatment for HCC-CL.…”

Superselective Transarterial Chemoembolization for Unresectable or “Ablation Unsuitable” Hepatocellular Carcinoma in the Caudate Lobe: A Real World, Single-Center Retrospective Study

“…Hepatocellular carcinoma (HCC) is a common malignancy, with incidence and mortality rates ranking sixth and third in the world, respectively (1). Cases of HCC arising or involving the caudate lobe (HCC-CL) are relatively rare, and its incidence is reported to be between 1.9% and 12.4% (2)(3)(4)(5)(6)(7). Although the implementation of surveillance programs for high-risk populations and advances in imaging diagnostic technology have increased the diagnosis rate of HCC-CL (8,9), about 80% of patients have tumors that are unresectable owing to either severe hepatitis-related cirrhosis or tumor invasion of the intrahepatic vessels (10).…”