Preoperative chemoembolization of hepatocellular carcinoma: a comparative study

Area of Science:

• Hepatobiliary Surgery
• Interventional Radiology
• Oncology

Background:

• Hepatocellular carcinoma (HCC) is a primary liver malignancy.
• Surgical resection is a curative option for resectable HCC.
• Neoadjuvant therapies aim to improve surgical outcomes.

Purpose of the Study:

• To evaluate the effectiveness and safety of preoperative chemoembolization (CE) before surgical resection of hepatocellular carcinoma.
• To assess the impact of CE on tumor characteristics, surgical procedure, and patient outcomes.

Main Methods:

• A before-after trial design comparing HCC patients who underwent liver resection with (CE group) and without (control group) preoperative CE.
• Patients were matched for tumor size and liver disease severity.
• Twenty-four patients were included in each group, treated between 1986 and 1992.

Main Results:

• Preoperative CE did not significantly reduce tumor size or alpha-fetoprotein levels.
• CE induced tumor necrosis but did not improve encapsulation, invasion, venous permeation, or surgical margins.
• While CE complicated surgery in 37% of cases (pediculitis, gallbladder lesions), it did not alter the postoperative course.
• Disease-free and overall survival rates at 3 years were comparable between the CE and control groups.

Conclusions:

• There is insufficient evidence to support the routine use of preoperative CE for initially resectable hepatocellular carcinoma.
• Further research is needed to identify specific patient subgroups who might benefit from neoadjuvant CE.