Uchida M, Kohno H, Kubota H, Hayashi T, Yamanoi A, Kimoto T, Ono T, Nagasue N
Second Department of Surgery, Shimane Medical University, Izumo, Japan.
World J Surg. 1996 Mar-Apr;20(3):326-31. doi: 10.1007/s002689900052.
To clarify the effect of preoperative transcatheter arterial oily chemoembolization (TAOE) for resectable hepatocellular carcinoma (HCC) on long-term survival after curative resection, we retrospectively evaluated 60 patients with and 68 patients without preoperative TAOE. Although there was no substantial difference in the clinical backgrounds between the two groups, the 5-year survival rate was lower for the patients with preoperative TAOE than for those without TAOE: 24% versus 63%, respectively (p < 0.05). A worse survival rate was particularly observed for the cirrhotic patients with TAOE than for those without TAOE: 35% and 72% at 4 years, respectively (p < 0.01). As the cause of death, liver failure and gastrointestinal bleeding were more frequent in the patients with TAOE (13.3% versus 1.5%;p < 0.05). Although the TAOE seemed to retard intrahepatic recurrence during the first 1.5 years after operation (1.7% versus 10.3%;p < 0.05), the overall cancer death rate was similar between the two groups (18.3% versus 11.8%). Therefore we suggest that preoperative TAOE must not be performed for resectable HCC as a routine procedure, particularly in patients with cirrhosis. A prospective randomized trial is warranted to elucidate the merits and demerits of preoperative TAOE for surgically resectable HCC.
为明确术前经导管动脉油性化疗栓塞术（TAOE）对可切除肝细胞癌（HCC）根治性切除术后长期生存的影响，我们回顾性评估了60例行术前TAOE的患者和68例未行术前TAOE的患者。尽管两组患者的临床背景无显著差异，但行术前TAOE患者的5年生存率低于未行TAOE的患者：分别为24%和63%（p<0.05）。尤其观察到，肝硬化且行TAOE的患者生存率比未行TAOE的患者更差：4年时分别为35%和72%（p<0.01）。作为死亡原因，TAOE患者中肝衰竭和胃肠道出血更为常见（13.3%对1.5%；p<0.05）。尽管TAOE似乎在术后1.5年内延缓了肝内复发（1.7%对10.3%；p<0.05），但两组的总体癌症死亡率相似（18.3%对11.8%）。因此，我们建议对于可切除的HCC，尤其是肝硬化患者，不应将术前TAOE作为常规操作。有必要进行一项前瞻性随机试验，以阐明术前TAOE对手术可切除HCC的利弊。
