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Preoperative chemoembolization for hepatocellular carcinoma

M Morino1, C Miglietta, M Grosso

  • 1Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, University of Turin, Italy.

Journal of Surgical Oncology. Supplement
|January 1, 1993
PubMed
Summary

Preoperative chemoembolization for hepatocellular carcinoma (HCC) led to significant tumor necrosis in 58% of patients. Further trials are recommended to assess its impact on long-term survival and recurrence.

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Area of Science:

  • Hepatobiliary Surgery
  • Interventional Radiology
  • Oncology

Background:

  • Hepatocellular carcinoma (HCC) is a primary liver malignancy.
  • Chemoembolization is an established palliative treatment for HCC.
  • The role of preoperative chemoembolization in surgical candidates requires further investigation.

Purpose of the Study:

  • To evaluate the outcomes of patients with HCC who underwent surgery after chemoembolization.
  • To assess the histological response to preoperative chemoembolization.
  • To determine the feasibility and safety of combining chemoembolization with surgical resection or transplantation.

Main Methods:

  • Retrospective analysis of 396 patients with HCC treated with chemoembolization between 1984 and 1991.
  • Sixty-seven patients underwent subsequent surgical treatment (resection or transplantation).

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  • Histological examination of resected specimens was performed to assess tumor necrosis.

    • Main Results:

    • A total or subtotal tumor necrosis was observed in 58% of resected specimens.
    • An additional 18% showed 50-80% tumor necrosis.
    • Morbidity included hepatic insufficiency, arterial thrombosis, vasculitis, cholecystitis, and hepatic abscess. Perioperative mortality rates were 5.5% for transplantation and 6.7% for resection.

    Conclusions:

    • Preoperative chemoembolization demonstrates a significant tumoricidal effect in a majority of HCC patients.
    • The procedure is associated with manageable perioperative morbidity and mortality.
    • A prospective multicentric trial is warranted to definitively evaluate the role of preoperative chemoembolization in improving long-term survival and reducing recurrence rates in HCC.