PREOPERATIVE CHEMOEMBOLIZATION OF HEPATOCELLULAR-CARCINOMA - A COMPARATIVE-STUDY

Objective: To assess the efficacy and adverse effects of preoperative transcatheter chemoembolization (CE) on surgical resection, postoperat ive outcome, and recurrence of hepatocellular carcinoma. Design: A bef ore-after trial comparing a group of patients undergoing liver resecti on after CE (CE group) with a group of patients undergoing liver resec tion without prior CE (control group), matched for tumor size and unde rlying liver disease. Setting: A tertiary care university hospital in a metropolitan area. Patients: Twenty-four patients in each group, tre ated between 1986 and 1992. Interventions: A mean of 1.6+/-0.2 preoper ative CE procedures were performed per patient in the CE group. Tumore ctomies, segmentectomies, and major liver resections were performed wi th a comparable frequency in each group. Results: Overall, CE was not associated with a significant reduction of tumor size (7.8+/-1 cm prio r to CE vs 7.1+/-1 cm after CE) or alpha-fetoprotein levels (2560+/-20 91 mu g/L prior to CE vs 1788+/-1270 mu g/L after the last CE). Chemoe mbolization promoted tumor necrosis but did not influence tumor encaps ulation, invasion of the capsule, venous permeation, presence of daugh ter nodules, or surgical margins. Liver resection was rendered more di fficult by preoperative CE as a result of pediculitis and gallbladder lesions in 37% of patients, but the postoperative course was not alter ed. Disease-free survival (33%+/-12% vs 32%+/-12% at 3 years) and over all survival were comparable. Conclusions: Convincing evidence is lack ing to support systematic preoperative CE in patients with initially r esectable hepatocellular carcinoma. Further studies should aim to iden tify the subgroup of patients who may benefit from this neoadjuvant tr eatment.