Influence of transcatheter arterial chemoembolization on the prognosis after hepatectomy for hepatocellular carcinoma in patients with severe liver dysfunction.

BACKGROUND The influence of preoperative transcatheter arterial chemoembolization (TACE) on postoperative survival and recurrence of hepatocellular carcinoma (HCC) after resection is still controversial. The effect of preoperative TACE on the prognosis of HCC after hepatectomy in 243 patients with liver dysfunction was evaluated. MATERIALS AND METHODS Among 243 patients who underwent curative resection of HCC between 1992 and 2005, 124 patients had an indocyanine-green retention rate at 15 min (ICGR15) of <17% (49 underwent TACE), while 119 patients had an ICGR15 of > or =17% (66 underwent TACE). The clinical characteristics, operative results and long-term survival were compared between patients with and without preoperative TACE who had mild or severe liver dysfunction. RESULTS There was no significant difference in the recurrence-free and overall survival rates between the TACE and no TACE groups with an ICGR15 <17%. Among the 119 patients with an ICGR15 > or =17%, there were no significant differences of preoperative characteristics, operative findings, or histology between the two groups. However, the post-resection disease-free and overall survival rates of 66 patients who underwent TACE were significantly better than those of 53 patients who did not have TACE (p = 0.009 and p = 0.0099, respectively). Using multivariate analysis, preoperative TACE was independently associated with better disease-free and overall survival after resection in patients with an ICGR15 > or =17% (p = 0.0309 and p = 0.0162, respectively). CONCLUSION Preoperative TACE did not alter the prognosis after resection of HCC in patients with mild liver dysfunction, but it did improve the prognosis of patients with severe liver dysfunction.