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Preresection transarterial chemoembolization for hepatocellular carcinoma: An experience with 23 patients

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Abstract

Purpose

The routine use of transarterial chemoembolization (TACE) prior to resection for hepatocellular carcinoma (HCC) is not recommended, although its use in the transplant setting is gaining popularity. In the absence of other effective neoadjuvant or adjuvant treatment options, TACE may benefit selected patients. The aim was to evaluate the feasibility and outcomes of preoperative TACE for selected patients with HCC.

Methods

From November 2010 to October 2012, 23 patients of HCC were selected by a multidisciplinary team to undergo TACE prior to resection.

Results

TACE was successful in all patients with no intraprocedural complications. TACE reduced the mean maximum tumor diameter from 9.2 to 8.2 cm and increased the mean future liver remnant (FLR) from 37.7 % to 49.1 %. Nineteen resections were completed with negative margins, of which only three patients (15.8 %) had cirrhosis. Two patients (10.5 %) experienced postoperative bile leaks and six patients (31.5 %) developed postoperative liver failure, two (10.5 %) of which succumbed to grade C liver failure. From the date of surgery, the median follow up time was 17.1 months. Four patients (17 %) did not undergo curative resection due to disease progression in three patients and severe TACE toxicity in one patient. None of the resected patients developed disease recurrence and the overall survival was 21 months.

Conclusion

Encouraging outcomes in terms of disease recurrence and overall survival need to be balanced with the risk of surgical drop out and perioperative complications when selecting patients for TACE prior to resection.

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Conflict of interest

MG, VG, TD, SK,NS, and SVS declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and the authors followed the policy concerning Informed Consent as shown on Springer.com

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Authors and Affiliations

  1. Division of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, 400 012, India

    Mahesh Goel, Vinay Gaikwad & Shailesh V. Shrikhande

  2. Division of Interventional Radiology, Tata Memorial Hospital, Parel, Mumbai, 400 012, India

    Tejas Dharia, Suyash Kulkarni & Nitin Shetty

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  1. Mahesh Goel
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  2. Vinay Gaikwad
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Correspondence to Shailesh V. Shrikhande.

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Goel, M., Gaikwad, V., Dharia, T. et al. Preresection transarterial chemoembolization for hepatocellular carcinoma: An experience with 23 patients. Indian J Gastroenterol 33, 432–439 (2014). https://doi.org/10.1007/s12664-014-0490-y

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