Clinical Significance of Preoperative Transcatheter Arterial Embolization in Hepatocellular Carcinoma

ABSTRACT

PURPOSE: Transcatheter arterial embolization (TAE) is widely used as a diagnostic and therapeutic tool for hepatocellular carcinomas (HCC). Although there are many controversies about the effect of preoperative TAE, in some centers, it has been done in most patients with HCC. We investigated the effect of preoperative TAE on the prognosis for the patients who had undergone curative hepatic resection for HCC. METHODS: We retrospectively studied 541 patients who had undergone curative hepatic resection for HCC at the Department of Surgery in Seoul National University Hospital between 1988 and 1995. Among those, preoperative TAE was done in 489 patients (TAE (+) group) and was not done in 52 patients (TAE (-) group). We examined demographics, tumor-free survival rate, overall survival rate, and complications. RESULTS: There were no statistical differences of demographic data between TAE (+) and TAE (-) groups. The 1-year, 3-year and 5-year tumor-free survival rates for TAE (+)/TAE (-) groups were 72.9%/70.6%, 43.8%/36.7% and 35.7%/30.5%, respectively. There was no statistical difference. The 1-year, 3-year and 5-year overall survival rates for TAE (+)/TAE (-) group were 85.5%/86.0%, 69.1%/63.3% and 56.6%/51.7%, respectively. These differences were not statistically significant (p>0.05). The postoperative complication rates were 26.6% for patients undergoing pre operative TAE and 26.9% for patients not undergoing it; these differences were not statistically significant (p>0.05). In the patients who had preoperative TAE, the hospital stay was prolonged (24.4+/-11.4 days vs. 17.8+/-8.8 days) and cost increased significantly (about 1,300,000 won). CONCLUSION: Preoperative TAE shows no advantages in the treatment of resectable HCC. Rather, it prolongs hospital stay and increases cost. Therefore, preoperative TAE should be done only in selected patients.