Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Effect of neoadjuvant transarterial chemoembolization followed by resection versus upfront liver resection on the survival of single large hepatocellular carcinoma patients: A systematic review and meta-analysis

  • Indah Jamtani (Digestive Surgery Division, Department of Surgery, Cipto Mangunkusumo Hospital, Universitas Indonesia) ;
  • Toar Jean Maurice Lalisang (Digestive Surgery Division, Department of Surgery, Cipto Mangunkusumo Hospital, Universitas Indonesia) ;
  • Wawan Mulyawan (Indonesian Air Force Institute of Aviation Medicine)
  • Received : 2024.01.09
  • Accepted : 2024.04.02
  • Published : 2024.08.31
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Abstract

Backgrounds/Aims: The efficacy of neoadjuvant transarterial chemoembolization (N-TACE) in resectable hepatocellular carcinoma (HCC) remains open to debate. While N-TACE may reduce tumor size, its impact on long-term outcomes is inconclusive. Methods: This meta-analysis reviewed studies on N-TACE before surgical resection vs. liver resection (LR) single large hepatocellular carcinoma (SLHCC) up to March 2023 from four online databases. Results: Five studies with 1,556 patients were analyzed. No significant differences between N-TACE and LR groups were observed in 1-, 3-, or 5-year overall survival (OS) and disease-free survival (DFS). No significant differences were noted in intraoperative blood loss between groups. Subgroup analysis showed favorable 1-, 3-, and 5-year OS with combination chemotherapy N-TACE (combination group), and better 1-year OS in the LR group with single-agent chemotherapy N-TACE (single-agent group). Five-year DFS favored LR in the single-agent group, and N-TACE in the combination group. Conclusions: Managing SLHCC requires intricate considerations, and the treatment strategies for this challenging subgroup of HCC need to be improved. The influence of N-TACE on long-term survival depends on the specific chemotherapy regimen employed, and its impact on intraoperative blood loss in SLHCC appears limited.

Keywords

Acknowledgement

This research paper owes its success to the invaluable contributions of several individuals. I extend my heartfelt gratitude to Mega Hasanul Huda, PhD, whose expertise in statistical analysis has been instrumental in interpreting our findings. Her insights and suggestions have greatly enhanced the quality of this manuscript. I am also immensely grateful to Ihya Fakhrurizal Amin, MD, for his diligent data collection and analysis. His meticulous work laid the foundation for our study. Furthermore, his role as the second reviewer for the included studies provided an essential layer of scrutiny and academic rigor, ensuring the reliability and validity of our research. Their combined efforts have been pivotal in realizing this project, and I sincerely appreciate their contributions.

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