The Effect of Preoperative Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

ABSTRACT

OBJECTIVE: To evaluate the impact of preoperative transarterial chemoembolization (TACE) for the treatment of patients undergoing curative liver resection for hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Preoperative TACE was performed in 164 of 339 HCC patients that had a curative resection and follow-up. Retrospective clinico-pathological analysis was performed with regard to the safety and response to treatment, early and late incidence and the pattern of recurrence as well as survival. RESULTS: For 159 patients in the TACE group (96.9%), TACE was performed preoperatively only once. The mean waiting time from TACE to resection was 19.5 days. There was no difference in the operative time, postoperative mortality and duration of hospital stay after resection between the two groups (patients that underwent TACE and patients that did not undertake the procedure). Ed-highlight-you did not define the two groups-is the above description in parentheses accurate? Microvascular invasion was significantly decreased in the TACE group (p < 0.01) and complete necrosis of the tumor was induced in 21 patients (12.8%) of the TACE group. Early and late recurrence patterns were not different between patients in the two groups. Overall survival and disease-free survival rate was not different between patients in both groups. However, the 3 year disease-free survival rate was significantly improved in the TACE group (p = 0.04) and the 3 year disease-free survival rate was also improved (p = 0.06), especially for patients with AJCC stage I or II. Multivariate analysis showed microvascular invasion, large tumor size, the presence of daughter nodules, gross portal invasion, Child classification and histological stage of cirrhosis to be risk factors for HCC recurrence and poor survival. CONCLUSION: Preoperative TACE is a safe procedure and can improve early postoperative recurrence and survival, especially in stage I or II HCC patients.