Improved Survival with Resectionafter Transcatheter ArterialChemoembolization (TACE) for Unresectable Hepatocellular Carcinoma

Abstract

Aim: This retrospective study was undertaken to analyze the outcome of hepatic resection in hepatocellular carcinomas (HCCs) that shrunk after transcatheter hepatic arterial chemoembolization (TACE) in 65 patients with unresectable HCCs between June 1987 and September 1996. Materials and Methods: Among these 65 patients, the median diameter of the tumor was 9.9 cm (5.6–20.0) prior to the first TACE, after 1–6 times of TACE (median 3) the median tumor diameter reduced to 3.7 cm (1.9–12.5) prior to resection. The duration between the last TACE treatment and sequential resection varied from 1 to 9 months (median 2.5). Serum α-fetoprotein (AFP) levels were abnormal in 39 out of the 65 patients. In AFP producing HCCs, the AFP level returned to normal (≤20 µg/l) in 14 out of 39 patients (35.9%). Hepatic segmentectomy, multiple hepatic segmentectomy or partial hepatic resection were performed in 61 patients, right hemihepatectomy in 1, left trisegmentectomy in 2, and left hemihepatectomy in 1. Results: Tumor necrosis ranged from 40 to 100% and pathologically and complete tumor necrosis occurred in 11 patients (16.9%). Of 14 patients with AFP levels decreased to normal, 10 still had microscopic living tumor foci. The 1-, 3- and 5-year survival rates of the 65 patients were 80.0, 65.0 and 56.0% respectively. Conclusion: TACE treatment can provide a chance of tumor resection for those patients with initially judged unresectable HCCs, and liver resection should be performed when the tumor has shrunk to be resectable, even when the AFP level has returned to normal.

Preoperative Systemic Chemoimmunotherapy and Sequential Resection for Unresectable Hepatocellular Carcinoma

“…Conversion of unresectable to resectable disease is uncommon with TACE, except in one study from China. 11 Further, intraarterial treatment is in general not indicated in patients who have metastatic disease or a blocked portal venous system. Systemic chemotherapy is the only option for patients with unresectable HCC not suitable for intraarterial treatment.…”

“…Three of these four patients had complete pathologic remission. In a retrospective study from Shanghai, 11 65 of 360 patients (18%) with unresectable HCC underwent sequential resection after responding to preoperative TACE. The degree of tumor necrosis was 40% to 100%.…”

“…When we reported the first 50 patients in our phase II study using the same chemoimmunotherapy regimen, the resectability rate was 20%. 12 Therefore, looking at both studies, 11,12 sequential resection after preoperative chemoimmunotherapy or TACE should be possible in approximately 18% to 20% of patients with unresectable HCC. The lower resectability rate after chemoimmunotherapy (15/150 [10%]) observed in the present study may be attributed to the inclusion of patients who failed to respond to previous treatment or developed postoperative recurrence.…”

Long-Term Survival of a Patient with a Large Unresectable Hepatocellular Carcinoma: Case Report and Review of the Literature~!2010-04-28~!2010-05-29~!2010-07-23~!

“…Procedures with the potential to down-stage HCC for secondary resection include TACE [11], combined chemo- therapy and radiation [8], HACE, radioimmunotherapy and embolization [9], transarterial yttrium 90 microspheres [12], systemic chemoimmunotherapy [13], etc. Embolization of portal vein supplying that part of the liver containing the tumor have been seen to reduce tumor size [14].…”

Hepatocellular Carcinoma in a Low-Incidence Region

“…Transcatheter arterial chemoembolisation has been used to induce tumour shrinkage to render large liver tumours, initially deemed unresectable, eligible for resection [17]. Portal venous branch embolisation has been performed in patients with chronically damaged livers prior to major hepatic resection in order to induce compensatory hypertrophy of the future remnant liver [18].…”