title: Influence of preoperative transarterial lipiodol chemoembolization on resection and transplantation for hepatocellular carcinoma in patients with cirrhosis.
abstract: OBJECTIVE
  To investigate the impact of preoperative transarterial lipiodol chemoembolization (TACE) in the management of patients undergoing liver resection or liver transplantation for hepatocellular carcinoma.
  
  
  METHODS
  TACE was performed before surgery in 49 of 76 patients undergoing resection and in 54 of 111 patients undergoing liver transplantation. Results were retrospectively analyzed with regard to the response to treatment, the type of procedure performed, the incidence of complications, the incidence and pattern of recurrence, and survival.
  
  
  RESULTS
  In liver resection, downstaging of the tumor by TACE (21 of 49 patients [42%]) and total necrosis (24 of 49 patients [50%]) were associated with a better disease-free survival than either no response to TACE or no TACE (downstaging, 29% vs. 10% and 11 % at 5 years, p = 0.08 and 0.10; necrosis, 22% vs. 13% and 11% at 5 years, p = 0.1 and 0.3). Five patients (10%) with previously unresectable tumors could be resected after downstaging. In liver transplantation, downstaging of tumors >3 cm (19 of 35 patients [54%]) and total necrosis (15 of 54 patients [28%]) were associated with better disease-free survival than either incomplete response to TACE or no TACE (downstaging, 71 % vs. 29% and 49% at 5 years, p = 0.01 and 0.09; necrosis, 87% vs. 47% and 60% at 5 years, p = 0.03 and 0.14). Multivariate analysis of the factors associated with response to TACE showed that downstaging occurred more frequently for tumors >5 cm.
  
  
  CONCLUSIONS
  Downstaging or total necrosis of the tumor induced by TACE occurred in 62% of the cases and was associated with improved disease-free survival both after liver resection and transplantation. In liver resection, TACE was also useful to improve the resectability of primarily unresectable tumors. In liver transplantation, downstaging in patients with tumors >3 cm was associated with survival similar to that in patients with less extensive disease.
authors.affiliation: Hepatobiliary Surgery and Liver Transplant Research Center, Hôpital Paul Brousse, Villejuif, France.
authors.forename: P E
authors.initials: PE
authors.lastname: Majno
authors.forename: R
authors.initials: R
authors.lastname: Adam
authors.forename: H
authors.initials: H
authors.lastname: Bismuth
authors.forename: D
authors.initials: D
authors.lastname: Castaing
authors.forename: A
authors.initials: A
authors.lastname: Ariche
authors.forename: J
authors.initials: J
authors.lastname: Krissat
authors.forename: H
authors.initials: H
authors.lastname: Perrin
authors.forename: D
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D003287:Contrast Media; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D003287:Contrast Media; D007459:Iodized Oil