Transcatheter arterial chemoembolization for superficial hepatocellular carcinoma induces adhesion.

The therapies for hepatocellular carcinomas (HCCs) have remarkably developed during the recent one or two decades and the prognosis of HCC patients has subsequently much improved. At present we have been able to perform several therapeutic modalities for HCC, such as surgical resection, transplantation, loco-regional therapies including percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), and microwave coagulation therapy (MCT), chemotherapy, and transcatheter arterial embolization (TAE) and/or transcatheter arterial chemoembolization (TACE) [1]. According to the latest report of Liver Cancer Study Group of Japan during January 1, 2002 to December 31, 2003, 33.6% of 15,681 patients with HCC underwent surgical resection, 31.2% underwent locoregional therapy, 29.6% underwent TAE/TACE, 4.9% underwent chemotherapy, and 0.8% underwent the other therapy [2]. As the report, TA(C)E is one of the most frequently performed modalities for HCC in Japan and has been validated effective in the treatment for advanced stages of HCCs. However, the efficacy of ordinary TAE/TACE has not been able to expect complete response of the targeted HCC nodules. The rate of complete response of TAE/TACE was 27.8%, and the 5-year survival rate was 22.6%. These results of TAE/TACE seemed to be lower in comparison to those of loco-regional therapies including PEI, MCT, and RFA, whose complete response was 82.2% and 5-year survival 42%. In these situations, we have experienced membranous adhesions between superficial position of HCC nodules and peritoneum and/or omentum in some patients with these HCCs nodules treated with TAE/TACE prior to the laparoscopic loco-regional treatments for these nodules performed at our hospitals in order to achieve complete response [3]. With respect to the adhesion, we would like to consider the positive or negative efficacy of TAE/TACE for these HCC nodules and the usefulness of laparoscopic thermal ablation for these HCC nodules.