Hepatectomy with chemoembolization for treatment of hepatocellular carcinoma.

Background/aims: Details of patient survival after resection of advanced hepatocellular carcinoma following preoperative transcatheter arterial chemoembolization are unknown.

Methodology: One hundred and forty-eight patients with solitary hepatocellular carcinomas who had undergone curative hepatic resection were divided into transcatheter arterial chemoembolization (+) and (-) groups. We estimated the risk factors of survival and disease-free survival using 148 cases and determined the risk factors that were reduced by preoperative transcatheter arterial chemoembolization.

Results: Indocyanine green retention time, ductal invasion, intrahepatic metastasis, capsule formation, liver cirrhosis, and histologic stage were common significant predictors of survival and disease-free survival after hepatic resection. The 50% overall survival in the transcatheter arterial chemoembolization (+) and (-) groups was 60 and 47 months, and the 50% disease-free survival for them was 24 and 24 months, respectively (NS). The survival and disease-free survival rates were not related to whether the patients had undergone preoperative transcatheter arterial chemoembolization, even if the procedure had rendered the tumor completely necrotic. However, in patients with intrahepatic metastasis and ductal invasion, or at an advanced disease stage, survival in the transcatheter arterial chemoembolization (+) group was significantly better than that in the transcatheter arterial chemoembolization (-) group (p < 0.05).

Conclusions: In the treatment of hepatocellular carcinoma with poor prognosis, hepatic resection combined with preoperative transcatheter arterial chemoembolization improves the postoperative survival.