title: Effect of resection following downstaging of unresectable hepatocelluar carcinoma by transcatheter arterial chemoembolization.
abstract: BACKGROUND
  This retrospective study was undertaken to analyze the outcome of hepatic resection in fifty-two patients with unresectable hepatocellular carcinoma (HCC) between January 2004 and December 2008.
  
  
  METHODS
  Among these fifty-two patients, the mean diameter of the tumor was 7.9 cm (4.4 - 15.5 cm, median 8.5 cm) prior to the first transcatheter arterial chemoembolization (TACE). After 1 - 6 times of TACE (median 2), the median tumor diameter was reduced to 4.2 cm (0 - 8.4 cm) prior to resection. The duration between the last TACE treatment and sequential resection varied from one to six months (median 2.7 months). Serum a-fetoprotein (AFP) levels were abnormal in thirty-eight out of the fifty-two patients. In AFP producing HCCs, AFP levels returned to normal (≤ 400 µg/L) in twenty-five out of thirty-eight patients. Hepatic segmentectomy, multiple hepatic segmentectomy or partial hepatic resection were performed in forty-five patients, two underwent extended left hemihepatectomy, and one underwent right posterior branch portal vein thrombectomy. One patient received a right hemihepatectomy and three had left hemihepatectomies.
  
  
  RESULTS
  Complete tumor radiological response (CR) occurred in five patients (9.6%). There were three cases of perioperative mortality in the fifty-two patients (5.8%). One patient underwent salvaged orthotopic liver transplantation, and twenty-one patients observed tumor recurrence within two years. The 1-, 3- and 5-year survival rates of the fifty-two patients were 77.0% (n = 40), 55.0% (n = 29), and 52.0% (n = 28), respectively. The median survival time after surgery was 49 months (95% confidence interval 7.5 - 52.7 months).
  
  
  CONCLUSIONS
  TACE treatment provides a better chance for HCC resection in patients initially diagnosed with unresectable HCC. Furthermore, liver resection should be performed once the tumor is downstaged to be compatible for successful resection.
authors.affiliation: Department of Hepatobillary Surgery, General Hospital of Chinese People's Liberation Army, Beijing 100853, China. shixianjie301@yahoo.com.cn
authors.forename: Xian-Jie
authors.initials: XJ
authors.lastname: Shi
authors.forename: Xin
authors.initials: X
authors.lastname: Jin
authors.forename: Mao-Qiang
authors.initials: MQ
authors.lastname: Wang
authors.forename: Li-Xin
authors.initials: LX
authors.lastname: Wei
authors.forename: Hui-Yi
authors.initials: HY
authors.lastname: Ye
authors.forename: Yu-Rong
authors.initials: YR
authors.lastname: Liang
authors.forename: Ying
authors.initials: Y
authors.lastname: Luo
authors.forename: Jia-Hong
authors.initials: JH
authors.lastname: Dong
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies