Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland; Department of Liver Surgery, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Liver Surgery, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
HPB (Oxford). 2019 Nov;21(11):1497-1504. doi: 10.1016/j.hpb.2019.03.360. Epub 2019 Apr 17.
The benefit of transarterial radioembolization (TARE) in patients with unresectable hepatocellular carcinoma (HCC) is increasingly evidenced. However, data on outcome of liver transplantation or resection after TARE remain scarce. This study aimed to assess the safety and feasibility of surgery after TARE in patients with unresectable HCC.
Patients exclusively undergoing TARE followed by either orthotopic liver transplantation (OLT) or liver resection (LR) for HCC between 2012 and 2016 were included. Primary outcomes were postoperative morbidity and mortality. Secondary outcomes were overall survival (OS) and response to TARE.
Among 349 patients with HCC treated with TARE, 32 (9%) underwent either OLT (n = 22) or LR (n = 10), which represent the study cohort. In this group, TARE induced decreased viable nodules (p < 0.001), an efficient downsizing (p < 0.001) as well as a significant downstaging based on BCLC classification (p < 0.001). Overall, major complications and mortality after surgery occurred in 5 (16%) and 1 (3%) patients, respectively. For the whole study cohort, OS was 47 months while survival rates at 1-, 3- and 5-years reached 97%, 86% and 86%, respectively.
Liver surgery after TARE is feasible and safe. This strategy allows to offer a curative treatment in a subset of patients with unresectable HCC.
经导管动脉内放射栓塞术（TARE）治疗不能切除的肝细胞癌（HCC）的获益已得到越来越多的证实。然而，关于 TARE 后行肝移植或切除术的结果的数据仍然很少。本研究旨在评估 TARE 后行肝切除术或肝移植术的安全性和可行性。
本研究纳入了 2012 年至 2016 年间仅接受 TARE 治疗后行原位肝移植（OLT）或肝切除术（LR）治疗 HCC 的患者。主要观察终点为术后发病率和死亡率。次要观察终点为总生存期（OS）和 TARE 反应。
在 349 例接受 TARE 治疗的 HCC 患者中，有 32 例（9%）接受了 OLT（n=22）或 LR（n=10），这些患者构成了研究队列。在该组中，TARE 诱导了肿瘤活结节数量减少（p<0.001）、肿瘤有效缩小（p<0.001）以及 BCLC 分期的显著降级（p<0.001）。总体而言，术后主要并发症和死亡率分别为 5 例（16%）和 1 例（3%）。对于整个研究队列，OS 为 47 个月，1 年、3 年和 5 年的生存率分别达到 97%、86%和 86%。
TARE 后行肝切除术是安全可行的。该策略可使一部分不能切除的 HCC 患者获得治愈性治疗。
