SHI Xian-jie, JIN Xin, WANG Mao-qiang, WEI Li-xin, YE Hui-yi, LIANG Yu-rong, LUO Ying , DONG Jia-hong

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