Is transarterial chemoembolization necessary before liver transplantation for hepatocellular carcinoma?
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.
Pérez Saborido
Baltasar
B
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
Meneu
Juan Carlos
JC
Moreno
Enrique
E
García
Ignacio
I
Moreno
Almudena
A
Fundora
Yilian
Y
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