title: Is preoperative transarterial chemoembolization needed for a resectable hepatocellular carcinoma?
abstract: BACKGROUND
  Whether preoperative transarterial chemoembolization (TACE) has the therapeutic benefits in patients with resectable hepatocellular carcinoma (HCC) remains uncertain.
  
  
  METHODS
  We retrospectively investigated the influence of preoperative TACE on both disease-free survival and the pattern of recurrence after curative resection. From March 1998 to January 2005, a series of 273 patients who underwent curative resection for HCC were reviewed. Altogether, 120 patients underwent preoperative TACE, and 153 patients did not. We compared disease-free survival and the recurrence patterns between TACE and non-TACE groups, as well as between subgroups, stratified with regard to initial tumor size (< or =3 cm, 3-5 cm, >5 cm) and pathologic tumor stage (stage I-II and stage III-IVa). We also compared disease-free survival and the pattern of recurrence among the three groups: complete necrosis, incomplete necrosis, non-TACE groups.
  
  
  RESULTS
  The 1-, 3-, and 5-year disease-free survival rates were 76.0%, 57.7%, and 51.3%, respectively, in the TACE group and 70.9%, 53.8%, and 46.8%, respectively, in the non-TACE group. No significant difference was observed in disease-free survival or the pattern of recurrence between the TACE and non-TACE groups. Further analysis of disease-free survival and the pattern of recurrence between subgroups according to initial tumor size and tumor stage showed no significant differences. Complete necrosis of tumor was recognized in only 33 patients of the TACE group (p = 0.001). Among the three complete necrosis, incomplete necrosis, and non-TACE groups, no significant difference was observed in disease-free survival or the pattern of recurrence.
  
  
  CONCLUSIONS
  Preoperative TACE did not significantly improve the disease-free survival or the pattern of recurrence after curative resection of HCC. Even though this study is a retrospective analysis, preoperative TACE cannot be recommended as a routine procedure before hepatectomy for a resectable HCC.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seodaemun-Ku, Seoul, Korea.
authors.forename: Gi-Hong
authors.initials: GH
authors.lastname: Choi
authors.forename: Dong-Hyun
authors.initials: DH
authors.lastname: Kim
authors.forename: Chang-Moo
authors.initials: CM
authors.lastname: Kang
authors.forename: Kyung-Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Jin-Sub
authors.initials: JS
authors.lastname: Choi
authors.forename: Woo-Jung
authors.initials: WJ
authors.lastname: Lee
authors.forename: Byong-Ro
authors.initials: BR
authors.lastname: Kim
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009367:Neoplasm Staging; D011300:Preoperative Care; D012008:Recurrence; D012189:Retrospective Studies