title: Is transarterial chemoembolization necessary before liver transplantation for hepatocellular carcinoma?
abstract: BACKGROUND
  Transarterial chemoembolization (TACE) before liver transplantation (LT) for hepatocellular carcinoma (HCC) has been proposed to prevent tumor progression, thus decreasing tumor recurrence and increasing survival.
  
  
  METHODS
  We studied 46 patients undergoing LT for HCC who were divided in 2 groups--group A with pretransplant TACE (18 patients [39.1%]) and group B without pretransplant TACE (28 patients [60.9%])--and compared postoperative and long-term results between the 2 groups.
  
  
  RESULTS
  There were no statistical differences in morbidity, transfusion needles, and postoperative time between-and no acute arterial or portal complication in-the 2 groups. There were no statistical differences in tumor recurrence (16.7 % vs 36.4 %, P=.16) with regard to pathway (mainly extrahepatic) or time. In group A patients, mean survival was 89.3+/-21.7 months with 1-, 3-, and 5-year actuarial survival rates of 83.3%, 60.5%, and 60.5%, respectively. In group B patients, mean survival was 75.1+/-19.1 months with 1-, 3-, and 5-year actuarial survival rates of 77.2%, 58.7%, and 38.1%, respectively. The differences in mean survival were not statistically significant (PX .56), nor was 5-year disease-free survival, which was 54% in group A and 39.5% in group B (P=.8).
  
  
  CONCLUSIONS
  TACE is a safe procedure for candidates on the wait list who are scheduled for LT to treat HCC. Although TACE does not correlate with increased intraoperative difficulties or postoperative complications, it does not significantly improve tumor recurrence and survival.
authors.affiliation: Surgical Department of General, Digestive, and Abdominal Organ Transplantation, Hospital Universitario 12 de Octubre, Avda. De Córdoba Km. 5.400, Madrid, Spain. perezsb@hotmail.com
authors.forename: Baltasar
authors.initials: B
authors.lastname: Pérez Saborido
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Meneu
authors.forename: Enrique
authors.initials: E
authors.lastname: Moreno
authors.forename: Ignacio
authors.initials: I
authors.lastname: García
authors.forename: Almudena
authors.initials: A
authors.lastname: Moreno
authors.forename: Yilian
authors.initials: Y
authors.lastname: Fundora
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate