To explore the efficacy and safety of preoperative transarterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) with portal vein invasion.

Two hundred and nineteen patients, diagnosed as rescetable HCC and portal vein tumor thrombus (PVTT) via preoperative imaging and multidisciplinary consultation, were prospectively enrolled and allocated into two groups. In the immediate resection group (132 cases), patients received immediate surgical resection. In the preoperative TACE group (87 cases), patients underwent TACE before surgical resection. Stratal analysis was carried out of the survival difference between the two groups.

The 1-, 3-, 5-year overall survival rates and the median survival time were 52.4%, 19.1%, 13.1%, and 13.87 months for the immediate resection group; 57.1%, 27.2%, 21.1%, and 16.13 months for the preoperative TACE group (P=0.037). On the strata analysis of segmental PVTT group, the overall survival rates of the immediate resection group and preoperative TACE group were 61.0% and 92.9% at 1-year, 32.1% and 55.7% at 3-year, 20.1% and 47.8% at 5-year, respectively (P=0.012). However, comparing the 1-, 3-, 5-year overall survival rates between the two groups respectively, no significant difference was found of major PVTT group (P=0.272). No significant difference was found between the 2 groups in postoperative complications and hospital mortality.

The preoperative TACE is a safe and effective procedure for patients diagnosed as HCC with portal vein tumor thrombi, and will not increase the incidence of complications, especially for resectable HCC with segmental PVTT.