Introduction : A recent study showed that sequential selective transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) provided better future liver remnant (FLR) regeneration rate and disease-free survival following surgery compared with PVE alone. The present study aimed to clarify whether preoperative sequential TACE and PVE immediately right hemihepatectomy can reduce postoperative hepatocellular carcinoma (HCC) recurrence and improve long-term disease-free and overall survival.

Methods : Recurrence and survival outcomes were retrospectively evaluated in 205 patients with HCC who underwent right hemihepatectomy by a single experienced surgeon from November 1993 to November 2017. Patients were divided into four groups according to the procedure performed prior to the surgery: sequential TACE and PVE (n = 109), PVE-only (n = 38), TACE-only (n = 28), or none (n = 30).

Results : Baseline patient and tumor characteristics upon diagnosis were similar in all four groups, while TACE and PVE were well tolerated. The TACE and PVE group had a higher mean increase in percentage FLR volume compared with that the PVE-only group (17.46% ± 6.63% vs. 12.14% ± 5.93%, respectively; p = 0.001). The TACE and PVE group had significantly better overall and disease-free survival rates compared with the other groups (p = 0.00016 and 0.0105, respectively).

Conclusions : Sequential TACE and PVE prior to surgery can be an effective oncologic strategy for patients with HCC scheduled for major hepatic resection, including those with chronic liver injury. The active application of preoperative sequential TACE and PVE for HCC would allow more patients with marginal FLR volume to become candidates for