Review of preoperative transarterial chemoembolization for resectable hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is one of the few cancers whose incidence has been continually increasing over recent years. Resection of HCC offers the only hope for cure. However, recurrences are common in patients who have undergone resection. In our opinion, the effectiveness with which transarterial chemoembolization (TACE) as a neoadjuvant therapy for resectable HCC prevents recurrence and prolongs survival has not been conclusively demonstrated. All published meta-analyses have consistently failed to demonstrate that preoperative TACE improves the prognosis of resectable HCC. We believe that these published articles have several limitations and have our own views about the results of meta-analyses. It is very important that the scientific community shed more light on the pathogenesis of HCC and relate this to choice of therapy. This review mainly concerns our understanding of preoperative TACE for resectable HCC and briefly addresses desirable directions for future studies. Core tip: Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and third most frequent cause of cancer deaths. Resection of HCC offers the only hope for a cure, yet post-resection recurrence is common. The effectiveness of transarterial chemoembolization (TACE) as a neoadjuvant therapy for resectable HCC has not been conclusively demonstrated. All published meta-analyses have consistently failed to demonstrate its effectiveness. We believe these articles have several limitations and TACE is theoretically helpful in multinodular or infiltrative types of HCC.Gao ZH, Bai DS, Jiang GQ, Jin SJ. Review of preoperative transarterial chemoembolization for resectable hepatocellular carcinoma. World J Hepatol 2015; 7(1): 40-43 Available from:

Significance of presence of microvascular invasion in specimens obtained after surgical treatment of hepatocellular carcinoma

“…Previous studies using neoadjuvant systemic chemotherapy failed to show any survival benefit after curative resection for HCC . Several randomized controlled trials failed to show any significant effectiveness of preoperative TACE in patients with resectable HCC . Nishikawa et al .…”

Intraoperative radiofrequency ablation for hepatocellular carcinoma in 112 patients with cirrhosis: a surgeon's view

“…However, the arguments against the use of TACE are that it mainly involves well differentiated HCC and fails to completely kill poorly differentiated cells, with the residual HCC cells being more aggressive. Another counterargument is that incomplete tumor cell necrosis weakens adhesiveness within the tumor, facilitating the release of cancer cells from the primary focus into the distant bloodstream; also, employing TACE may complicate liver mobilization owing to the perihepatic adhesion [ 12 ].…”

Expression of cluster of differentiation 151 prior to and following transcatheter arterial chemoembolization therapy in patients with hepatocellular carcinoma and its association with clinicopathological characteristics

“…to the blood, which may result in intrahepatic or extrahepatic metastasis (9). Postoperative TACE may also damage the residual liver function and activate the hepatitis B virus, which may in turn lead to extrahepatic metastases and a poor prognosis (10,11).…”