Arterial chemoembolization in hepatocellular carcinoma suitable for resective surgery

Authors examined transcatheter arterial embolization (TAE) reliability in modifying diagnosis, staging, choice of treatment after a common instrumental evaluation and in increasing results in patients with hepatocarcinoma(s) potentially suitable for surgery; this value was compared to TAE-related mortality and morbidity.

Thirty-nine patients underwent TAE. Diagnostic value, reduction in tumor size and necrosis' percentage after treatment were computed. Immediate and long term results were compared to those obtained by primary liver resection in 62 patients.

TAE showed more lesions than any other diagnostic tool, thus excluding 4 patients (10.2%) from surgery. TAE-related mortality (1 patient) and severe morbidity (11 patients) excluded 4 more patients. Complications were correlated to Gelfoam embolization (p < 0.01). After TAE tumor size reduction was sporadic; tumor necrosis > 70% was present in 13/29 resected tumors. Intraoperatively 16/25 patients had TAE-related anatomical alterations; a choledochus' wall necrosis and a tumor' explosion must be mentioned. TAE and intraoperative echography had an equivalent diagnostic value. Immediate and long term results were comparable to those obtained by primary liver resection.

TAE has a high diagnostic accuracy but the capacity in changing the final judgment after a good instrumental evaluation is low. The specific risk-benefit ratio is not favourable, in particular after mechanical embolization, and clinical benefit is not evident.