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Sequential transcatheter arterial chemoembolization and portal vein embolization before hepatectomy for the management of patients with hepatocellular carcinoma: a systematic review and meta-analysis

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A Correction to this article was published on 19 July 2023

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Abstract

R0 resection is the gold standard for the treatment of hepatocellular carcinoma. However, residual liver deficiency remains a major obstacle to hepatectomy. This article aims to explore the short-term and long-term efficacy of preoperative sequential transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) in the treatment of hepatocellular carcinoma. Multiple electronic literature databases up to February 2022 were searched. Furthermore, clinical studies comparing sequential TACE + PVE with portal vein embolization (PVE) were included. The outcomes included hepatectomy rate, overall survival, disease-free survival, overall morbidity, mortality, posthepatectomy liver failure, the percentage increase in FLR. Five studies included 242 patients who received sequential TACE + PVE and 169 patients received PVE. The sequential TACE + PVE group demonstrated more favorable results in terms of hepatectomy rate (OR = 2.37; 95% CI 1.09–5.11; P = 0.03), overall survival (HR 0.55; 95% CI 0.38 to − 0.79; P = 0.001), disease-free survival (HR 0.61; 95% CI 0.44–0.83; P = 0.002), and percentage increase in FLR (MD = 4.16%; 95% CI 1.13–7.19; P = 0.007). The pooled results did not demonstrate significant differences in overall morbidity, mortality, and posthepatectomy liver failure between the sequential TACE + PVE and PVE groups. Preoperative sequential TACE + PVE has been shown to be a safe and feasible treatment for hepatocellular carcinoma to improve resectability, and it has been shown to provide better long-term oncological outcomes than PVE.

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  1. Yang Liao and Qichen Cai have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Zigong First People’s Hospital, # 42, Shangyihao 1St Branch Road, Ziliujing District, Zigong, 643000, Sichuan, China

    Yang Liao, Xiaozhou Zhang & Fugui Li

  2. Department of Hepatobiliary Surgery, Chengdu Second People’s Hospital, Chengdu, Sichuan, China

    Qichen Cai

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  1. Yang Liao
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  4. Fugui Li
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Correspondence to Fugui Li.

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Liao, Y., Cai, Q., Zhang, X. et al. Sequential transcatheter arterial chemoembolization and portal vein embolization before hepatectomy for the management of patients with hepatocellular carcinoma: a systematic review and meta-analysis. Updates Surg 75, 1741–1750 (2023). https://doi.org/10.1007/s13304-023-01571-y

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