Transcatheter arterial chemoembolization followed by surgical resection for hepatocellular carcinoma: a focus on its controversies and screening of patients most likely to benefit

Abstract

Surgical resection (SR) is recommended as a radical procedure in the treatment of hepatocellular carcinoma (HCC). However, postoperative recurrence negatively affects the long-term efficacy of SR, and preoperative adjuvant therapy has therefore become a research hotspot. Some clinicians adopt transcatheter arterial chemoembolization (TACE) as a preoperative adjuvant therapy in patients undergoing SR to increase the resection rate, reduce tumor recurrence, and improve the prognosis. However, the findings of the most relevant studies remain controversial. Some studies have confirmed that preoperative TACE cannot improve the long-term survival rate of patients with HCC and might even negatively affect the resection rate. Which factors influence the efficacy of preoperative TACE combined with SR is a topic worthy of investigation. In this review, existing clinical studies were analyzed with a particular focus on several topics: screening of the subgroups of patients most likely to benefit from preoperative TACE, exploration of the optimal treatment regimen of preoperative TACE, and determination of the extent of tumor necrosis as the deciding prognostic factor.

Effect of Perioperative Comprehensive Nursing Intervention on Transcatheter Arterial Chemoembolization in Patients with Primary Hepatic Carcinoma

“…TACE is a combination of medical imaging and clinical treatment that has become one of the most important treatments for the treatment of PHC, as it can help reduce tumor volume and allow for a second operation. Although liver resection or transplantation provides better results than other therapies in the local control of HCC, survival rates are unsatisfactory, particularly for large tumors, and it remains controversial whether HCC angiogenesis is enhanced after TACE even in patients undergoing radical resection [ 27 ]. It is frequently utilized in arterial infusion chemotherapy with chemotherapy drugs that are generally given all at once at a high concentration and large dose.…”

Hepatectomy versus transcatheter arterial chemoembolization for resectable BCLC stage A/B hepatocellular carcinoma beyond Milan criteria: A randomized clinical trial

“…However, it is controversial whether patients with resectable HCC should receive preoperative TACE preoperatively. Some studies have reported that preoperative TACE has adverse effects, such as perihepatic adhesions that make surgery more difficult, increase the risk of liver injury and liver failure, or delay surgery, thereby allowing continued tumor growth (25)(26)(27). Further, a meta-analysis concluded that HCC patients undergoing hepatectomy do not necessarily derive a survival advantage from preoperative TACE (28).…”

An mALBI-Child–Pugh-based nomogram for predicting post-hepatectomy liver failure grade B–C in patients with huge hepatocellular carcinoma: a multi-institutional study

“…In the overall cohort, 67.7% of the patients in the high-risk group developed severe PHLF, suggesting stricter standards on the surgical indications, as well as more careful perioperative management. For these patients, it might be safer to choose nonsurgical treatment [ 36 ], neoadjuvant systemic therapy [ 37 ], or TACE followed by hepatectomy [ 38 ]. In comparison with the high-risk group, patients in the low-risk group have a probability of 13.3% for developing PHLF grade B–C, thus considered more appropriate candidates for hepatectomy.…”