Preoperative chemoembolization for hepatocellular carcinoma.
In a group of 396 patients who had chemoembolization for hepatocellular carcinoma (HCC) between 1984 and 1991, 67 underwent surgery (segmentary/subsegmentary resections: 31; or transplantation: 36). Morbidity was limited to hepatic insufficiency (seven), arterial thrombosis (two), vasculitis (five), cholecystitis (two), and hepatic abscess (one). Perioperative mortality was 5.5% for transplantation and 6.7% for resection. Histological examination of resected specimens showed a total or subtotal tumor necrosis in 58% of the cases, and a necrosis between 50% and 80% in another 18%. Data on recurrence and long-term survival are not significant if retrospectively compared with non-chemoembolized surgically treated patients. Chemoembolization is known to be an effective palliative treatment of HCC. Its role in the preoperative setting is sustained by a 58% of total or subtotal histological necrosis. A multicentric prospective trial to evaluate the role of preoperative chemoembolization for long-term survival and recurrence of HCC is advocated.
Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, University of Turin, Italy.
M
M
Morino
C
C
Miglietta
M
M
Grosso
M
M
De Giuli
H
H
Bismuth
D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D002404:Catheterization; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage; D006498:Hepatectomy; D006499:Hepatic Artery; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009367:Neoplasm Staging; D011300:Preoperative Care; D015996:Survival Rate
D007459:Iodized Oil; D004317:Doxorubicin