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Resection Postradioembolization in Patients With Single Large Hepatocellular Carcinoma
Stylianos Tzedakis1, Amine Sebai1, Heithem Jeddou1
1Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, University of Rennes 1, Rennes, France.
Annals of Surgery
|August 4, 2023
Summary
Yttrium-90 transarterial radioembolization (TARE) can convert unresectable hepatocellular carcinoma (HCC) to a resectable state. TARE-treated patients achieved comparable short-term and long-term survival outcomes to those undergoing upfront surgery.
Area of Science:
- Hepatobiliary Surgery
- Interventional Radiology
- Oncology
Background:
- Transarterial radioembolization (TARE) is established for downstaging cholangiocarcinoma to enable resection.
- The role of TARE in improving resectability for hepatocellular carcinoma (HCC) remains under investigation.
Purpose of the Study:
- To evaluate the efficacy of Yttrium-90 transarterial radioembolization (TARE) in converting initially unresectable, single, large (≥5 cm) HCC to a resectable state.
- To compare short-term and long-term outcomes of TARE-converted resection versus upfront surgery for large HCC.
Main Methods:
- Retrospective review of consecutive patients with single large HCC treated between 2015-2020.
- Comparison of upfront surgery, TARE with conversion to resection (TARE-surgery), and TARE-only groups.
- Propensity score matching analysis to compare outcomes between upfront-surgery and TARE-surgery cohorts.
Main Results:
- Of 72 TARE patients, 20 (27.7%) were converted to resection. TARE-surgery patients received higher Yttrium-90 doses (211.89 Gy vs 128.7 Gy).
- Postoperative outcomes were similar between upfront-surgery and TARE-surgery groups.
- TARE-surgery showed significantly better overall survival than upfront-surgery after propensity score matching (P=0.021).
Conclusions:
- TARE serves as a valuable downstaging treatment for unresectable, single, large HCC.
- TARE can achieve comparable short-term and long-term outcomes to upfront resection for suitable HCC cases.
