Preoperative chemoembolization of hepatocellular carcinoma - A comparative study

Objective: To assess the efficacy and adverse effects of preoperative transcatheter chemoembolization (CE) on surgical resection, postoperative outcome, and recurrence of hepatocellular carcinoma. Design: A before-after trial comparing a group of patients undergoing liver resection after CE (CE group) with a group of patients undergoing liver resection without prior CE (control group), matched for tumor size and underlying liver disease. Setting: A tertiary care university hospital in a metropolitan area. Patients: Twenty-four patients in each group, treated between 1986 and 1992. Interventions: A mean of 1.6+/-0.2 preoperative CE procedures were performed per patient in the CE group. Tumorectomies, segmentectomies, and major liver resections were performed with a comparable frequency in each group. Results: Overall, CE was not associated with a significant reduction of tumor size (7.8+/-1 cm prior to CE vs 7.1+/-1 cm after CE) or alpha-fetoprotein levels (2560+/-2091 mu g/L prior to CE vs 1788+/-1270 mu g/L after the last CE). Chemoembolization promoted tumor necrosis but did not influence tumor encapsulation, invasion of the capsule, venous permeation, presence of daughter nodules, or surgical margins. Liver resection was rendered more difficult by preoperative CE as a result of pediculitis and gallbladder lesions in 37% of patients, but the postoperative course was not altered. Disease-free survival (33%+/-12% vs 32%+/-12% at 3 years) and overall survival were comparable. Conclusions: Convincing evidence is lacking to support systematic preoperative CE in patients with initially resectable hepatocellular carcinoma. Further studies should aim to identify the subgroup of patients who may benefit from this neoadjuvant treatment.