title: Role of transarterial chemoembolization before liver resection for hepatocarcinoma.
abstract: 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.
authors.affiliation: III Clinic of Surgery, Padova University, Padova, Italy. gerunda@ux1.unipol.it
authors.forename: G E
authors.initials: GE
authors.lastname: Gerunda
authors.forename: D
authors.initials: D
authors.lastname: Neri
authors.forename: R
authors.initials: R
authors.lastname: Merenda
authors.forename: F
authors.initials: F
authors.lastname: Barbazza
authors.forename: F
authors.initials: F
authors.lastname: Zangrandi
authors.forename: F
authors.initials: F
authors.lastname: Meduri
authors.forename: M
authors.initials: M
authors.lastname: Bisello
authors.forename: M
authors.initials: M
authors.lastname: Valmasoni
authors.forename: A
authors.initials: A
authors.lastname: Gangemi
authors.forename: A M
authors.initials: AM
authors.lastname: Faccioli
mesh_terms: D000368:Aged; D001158:Arteries; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008099:Liver / Q000473:pathology / Q000601:surgery*; D017093:Liver Failure / Q000401:mortality; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000401:mortality; D011300:Preoperative Care; D011446:Prospective Studies; D016019:Survival Analysis