Effect of resection following downstaging of unresectable hepatocelluar carcinoma by transcatheter arterial chemoembolization

• Published in: Chinese medical journal 2012-01, Vol.125 (2), p.197-202
• Main Authors: Shi, Xian-Jie, Jin, Xin, Wang, Mao-Qiang, Wei, Li-Xin, Ye, Hui-Yi, Liang, Yu-Rong, Luo, Ying, Dong, Jia-Hong
• Format: Article
• Language: English
• Subjects: Adult; Aged; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic - methods; Female; Hepatectomy; Humans; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Neoplasms - therapy; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; 化疗; 平均存活时间; 平均直径; 手术切除; 栓塞; 肝动脉; 肝癌; 部分肝切除
• ISSN: 0366-6999; 2542-5641
• DOI: 10.3760/cma.j.issn.0366-6999.2012.02.007

Background This retrospective study was undertaken to analyze the outcome of hepatic resection in fifty-two patients with unresectable hepatocellular carcinoma （HCC） between January 2004 and December 2008.Methods Among these fifty-two patients,the mean diameter of the tumor was 7.9 cm （4.4-15.5 cm,median 8.5 cm） prior to the first transcatheter arterial chemoembolization （TACE）.After 1-6 times of TACE （median 2）,the median tumor diameter was reduced to 4.2 cm （0-8.4 cm） prior to resection.The duration between the last TACE treatment and sequential resection varied from one to six months （median 2.7 months）.Serum α-fetoprotein （AFP） levels were abnormal in thirty-eight out of the fifty-two patients.In AFP producing HCCs,AFP levels returned to normal （≤400 μg/L） in twenty-five out of thirty-eight patients.Hepatic segmentectomy,multiple hepatic segmentectomy or partial hepatic resection were performed in forty-five patients,two underwent extended left hemihepatectomy,and one underwent right posterior branch portal vein thrombectomy.One patient received a right hemihepatectomy and three had left hemihepatectomies.Results Complete tumor radiological response （CR） occurred in five patients （9.6%）.There were three cases of perioperative mortality in the fifty-two patients （5.8%）.One patient underwent salvaged orthotopic liver transplantation,and twenty-one patients observed tumor recurrence within two years.The 1-,3- and 5-year survival rates of the fifty-two patients were 77.0% （n=40）,55.0% （n=29）,and 52.0% （n=28）,respectively.The median survival time after surgery was 49 months （95% confidence interval 7.5-52.7 months）.Conclusions TACE treatment provides a better chance for HCC resection in patients initially diagnosed with unresectable HCC.Furthermore,liver resection should be performed once the tumor is downstaged to be compatible for successful resection