Extrahepatic Feeding of HCC Limits the Use of TACE? Evidences from Literature and Clinical Experience

Trans-arterial chemoembolization (TACE) has been established as the standard of care for patients with intermediate stage of multinodular hepatocellular carcinoma (HCC), according to Barcelona Clinic Liver Cancer (BCLC) classification, and no extra-hepatic diffusion. The efficacy and safety of the procedure are related to the possibility of performing a superselective catheterization of the branches of the hepatic artery responsible for the vascularisation of the tumour. However, in some cases, the vascularisation of the nodules can be complex and arterial supply can derive from vessels originating from the extra-hepatic circulation. This condition, called extra-hepatic feeding, is not a rare finding, and can hamper the therapeutic efficacy of TACE. When investigating a candidate for TACE, anamnestic and radiological elements suggestive for the presence of extra-collateral arteries should be known and taken into account. Once diagnosed, although extra-hepatic feeding does not represent an absolute contraindication to TACE, it requires, in each case, a careful benefit-risk assessment, being impossible to establish a standard procedure. We here present a review of the available literature and a paradigmatic case of multifocal HCC with an extrahepatic feeding.