Preoperative chemoembolization for hepatocellular carcinoma

Abstract

In a group of 396 patients who had chemoembolization for hepatocellular carcinoma (HCC) between 1984 and 1991, 67 underwent surgery (segmentaryhbsegmentary resections: 3 1 ; or transplantation: 36). Morbidity was limited to hepatic insufficiency (seven), arterial thrombosis (two), vasculitis (five), cholecystitis (two), and hepatic abscess (one). Perioperative mortality was 5.5% for transplantation and 6.7% for resection.Histological examination of resected specimens showed a total or subtotal tumor necrosis in 58% of the cases, and a necrosis beween 50% and 80% in another 18%. Data on recurrence and long-term survival are not significant if retrospectively compared with non-chemoembolized surgically treated patients.Chemoembolization is known to be an effective palliative treatment of HCC. Its role in the preoperative setting is substained by a 58% of total or subtotal histological necrosis. A multicentric prospective trial to evaluate the role of preoperative chemoembolization for long-term survival and recurrence of HCC is advocated. 0 1993 Wiley-Liss, Inc.

Role of Transarterial Chemoembolization Before Liver Resection for Hepatocarcinoma

“…10,11,[22][23][24][25] Early recurrence is generally correlated with understaging, 4,10,25-28 incomplete tumor excision, 11,[25][26][27][29][30][31][32] or multiple tumor cell dissemination inside or outside the liver through the portal venous system 33 during surgical manipulation of the tumorous livers. 4,13,34,35 Microscopic residual disease in the remaining liver can develop soon after LR, partly because resection itself leads to regeneration and is the most potent growth stimulus for liver-derived cells known to date. 26 Because the regeneration process is unable to affect the diseased parenchyma in a patient with cirrhosis, 36 a growth response can only be expected in the neoplastic hepatocytes.…”

“…This increases resectability, prevents cancer cell dissemination during surgery, sterilizes undetected lesions, and ultimately improves the survival rate. [12][13][14][15][16][17][18][19][20] The aim of our study is to clarify in a prospective trial whether preoperative TACE can reduce HCC recurrence after LR and improve disease-free and overall survival.…”

Influencia del tratamiento del hepatocarcinoma antes del trasplante hepático en la recurrencia tumoral y supervivencia postrasplante

“…Así, el estudio retrospectivo de Veltri et al 14 con controles históricos mostraba una mejor supervivencia en los pacientes tratados con TACE, pero sólo cuando se combinaba con IPE. Otros 5 estudios no controlados indicaban un cierto beneficio de la TACE realizada antes del TH [15][16][17][18][19] . En cambio, Ravaioli et al 20 observaron cómo la obtención de necrosis parcial tras la TACE era una variable predictora de recurrencia tumoral tras el TH.…”

A Decision Analysis Model Identifies the Interval of Efficacy for Transarterial Chemoembolization (TACE) in Cirrhotic Patients with Hepatocellular Carcinoma Awaiting Liver Transplantation

“…[2][3][4][5] However, other studies have found no impact on this endpoint. 6,7 Despite early promising results from well-designed single center studies, [8][9][10] no study has proven that neoadjuvant TACE improves post transplant disease-free survivals. [11][12][13][14][15] The variability in response rates to TACE suggest that there are multiple factors which influence outcome after this treatment.…”