A Prospective Randomized Trial of the Preventive Effect of Pre‐operative Transcatheter Arterial Embolization against Recurrence of Hepatocellular Carcinoma

Abstract

To clarify whether pre‐operalive transcatheter arterial embolization (TAE) improves survival after hepatectomy, a prospective randomized comparative study was done. Of a total of 115 registered patients having solitary hepatocellular carcinoma (HCC) 2 to 5 cm in diameter, 18 (15.7%) were excluded after randomization. As a result, 97 patients were chosen as subjects and divided into two groups: hepatectomy with (group A: n = 50) and without (group B: n=47) pre‐operative TAE. The period of observation of the patients who survived the surgery was between 4.0 and 6.6 years. The randomization appeared to have provided well‐balanced groups of patients and the clinico‐pathological characteristics of the two groups were quite similar. The necrotic part of the cancerous lesions, as confirmed by operative specimens, amounted to 74.8 ±33.4% (mean±SD) in group A and 6.8 ±7.2% in group B (P<0.01). However, the cancer‐free survival rates after hepatectomy in both groups showed little difference (39.1±7.0 (%±SE) and 31.1±0.1, respectively). We speculate that TAE is not effective against such HCC accessory lesions as minute intrahepatic metastasis and tumor thrombus and that pre‐operative TAE does not improve post‐operative survival.

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

“…The use of cTACE prior to resection of HCC has been examined in 3 RCTs, universally yielding negative results in terms of OS and DFS (47)(48)(49). One such study, published by Zhou et al (47) delineated the negative impact of preoperative cTACE on a range of parameters including post-cTACE complications, impairment of liver function and increased technical difficulty for future transarterial treatments.…”

Management of hepatocellular carcinoma

“…27,209 Chemoembolization of the tumor prior to resection offers no benefit. 210 The same is true for the general use of portal vein embolization of the hepatic lobe hosting the tumor 211,212 to induce compensatory liver growth and functional capacity in the non-affected lobe prior to a major resection. It has also been suggested that malignant hepatocytes may also respond to the proliferative stimulus and this could result in uncontrolled tumor progression.…”

Prevention of intrahepatic distant recurrence by transcatheter arterial infusion chemotherapy with platinum agents for stage I/II hepatocellular carcinoma

“…19,20 One was a multicenter, randomized, controlled trial conducted in Japan that examined the effects of preoperative TAE without any chemotherapeutic agents in patients with HCC who had 20 If the purpose of preoperative TAE (or TACE) is to prevent tumor spread arising from intrahepatic micrometastases that are present at the time of hepatectomy or from intraoperative manipulation, then it is not beneficial to perform preoperative TAE (or TACE) uniformly, regardless of whether patients have intrahepatic micrometastases. However, it may be possible to demonstrate the efficacy of preoperative TAE (or TACE) if the procedure is undergone by patients who have intrahepatic micrometastases or the possibility of intraoperative tumor spread.…”