Pre-operative chemoembolization of hepatocellular carcinoma in cirrhotic patients

BACKGROUND/AIMS: The aim of the study was to evaluate clinical and patholog ical effects of transcatheter arterial chemoembolization (TACE) before surg ical resection for hepatocellular carcinoma (HCC) in cirrhosis (55 patients ); results were compared with a group of 45 patients undergoing surgical re section without TACE. METHODOLOGY: From March 1989 to December 1997, 55 cirrhotic patients, affec ted by surgically resectable HCC not larger than 5cm with unifocal or bifoc al tumor lesions, underwent TACE preoperatively. RESULTS: Massive necrosis was observed in 26%, necrosis >50% in 38% of lesi ons. Neoplastic cells were found in 47% of cases within the capsule or in t he pericapsular tissue. Satellite nodules showed a low rate of necrosis. Mo rtality and morbidity in the pre-operative TACE group were 1,8% and 29%, re spectively, and 4,4% and 33%, respectively, in the control group. One-, 3- and 5-year patient survival rates were 87%, 70% and 39%, respectively, vers us 79%, 38% and 19%, respectively (p<0.02), in the control group. Disease-f ree survival was 40% and 28% at 3 years and 5 years with pre-operative TACE versus 20% and 11% (p<0.05). CONCLUSIONS: Pre-operative TACE can be performed with low morbidity. TACE c an necrotize the main lesion and temporarily arrest portal diffusion of neo plastic cells by acting on microvascular infiltration. No evident effect on satellites and pericapsular neoplastic foci was observed. The long-term pa tients and disease-free survival rates were improved upon.