Significance of transcatheter chemoembolization combined with surgical resection for hepatocellular carcinomas

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Abstract
In order to improve the survival rate after liver resection for hepatocellular carcinoma (HCC), 71 HCC patients were treated with transcatheter chemoembolization (TCE). In the present study, we analyzed the effects of TCE on the patients' survival rates, as well as on the liver specimens resected in a histopathological study, comparing those not treated with TCE (n = 21). The overall survival rates, including hospital mortality, for 1 year, 3 years and 5 years were 81%, 72% and 54% respectively. However, no differences were observed in the survival rates between the TCE and the non-TCE groups. A histopathological study demonstrated that TCE was quite effective on the main tumor but not on intrahepatic metastasis or on tumor thrombus in the portal vein. However, we found that most of the intrahepatic metastatic lesions were necrotized in 8 of the 30 cases with these lesions. The histopathological study proved that these particular cases had some abnormalities in the portal blood supply. All but one of them are currently alive 3-48 months after resection, although the prognosis of the patients who had intrahepatic metastasis or a tumor thrombus in the portal vein was extremely poor. Preoperative TCE may, therefore, be thought of as a useful modality when it is effective in killing intrahepatic metastases. To control the lesions, portal vein embolization may be a promising technique in the future.