Role of Transarterial Chemoembolization Before Liver Resection for Hepatocarcinoma

• Published in: Liver transplantation Vol. 6; no. 5; pp. 619 - 626
• Main Authors: Gerunda, Giorgio Enrico, Neri, Daniele, Merenda, Roberto, Barbazza, Franco, Zangrandi, Fabio, Meduri, Francesco, Bisello, Marco, Valmasoni, Michele, Gangemi, Antonio, Faccioli, Alvise Maffei
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-09-2000; W.B. Saunders
• Subjects: Aged; Arteries; Carcinoma, Hepatocellular - surgery; Embolization, Therapeutic - methods; Female; Humans; Incidence; Liver - pathology; Liver - surgery; Liver Failure - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Male; Middle Aged; Necrosis; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - prevention & control; Postoperative Complications - mortality; Preoperative Care; Prospective Studies; Survival Analysis
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1053/jlts.2000.8312

The aim of this study was to clarify whether chemoembolization (TACE) before liver resection (LR) can reduce postoperative hepatocellular carcinoma (HCC) recurrence and improve disease-free and overall survival. Eighty-nine patients with tumor-stage (TNM) I-II HCC were evaluated for LR. Patients were prospectively allocated to LR alone or TACE plus LR based on their place of residence. Twenty nonlocal patients (24%) were selected for LR, while 69 (77.5%) local patients were selected for TACE plus LR. Following TACE, the tumor stage could be confirmed in only 20 patients (29%) who then underwent LR. Operative mortality was 0%, but in the TACE-LR group, 3 patients died of liver failure between 2 and 5 months after surgery. Early recurrence (<24 months) was 59% for LR versus 20% for TACE plus LR (P < .05). Late recurrence was 18% for LR versus 10% for TACE plus LR (P = not significant [NS]). The overall recurrence rate was 76% for LR versus 30% for TACE plus LR (P < .02). Death due to HCC recurrence was 70% for LR versus 15% for TACE plus LR (P < .05). The overall 1- and 5-year survival rates did not differ significantly (71% to 38% for LR v 85% to 43% for TACE + LR; P = NS), whereas the difference in 1- and 5-year disease-free survival was highly significant (64% to 21% for LR v 82% to 57% for TACE + LR; P < .02). TACE was able to improve the HCC staging process and significantly reduce the incidence of early and overall HCC recurrence and related death after LR; it improved the disease-free interval, but not the overall survival, due to an increase in liver failure in the first 5 months. (Liver Transpl 2000;6:619-626.)