Background/Objectives: Preoperative strategies for hepatocellular carcinoma (HCC) requiring major hepatectomy remain controversial, particularly in “borderline resectable” cases. This study aimed to evaluate the oncological benefit and perioperative safety of Yttrium-90 transarterial radioembolization (TARE) in patients undergoing right or extended right hepatectomy for HCC.Material and Methods: All consecutive patients who underwent right or extended right hepatectomy for HCC at a single tertiary center between January 2013 and December 2023 were retrospectively reviewed. Patients were grouped based on whether they received preoperative TARE or underwent upfront resection. Outcomes analyzed included perioperative morbidity and long-term oncological endpoints.Results: A total of 39 patients were included, of whom 18 received preoperative TARE and 21 underwent upfront surgery. Patients in the TARE group showed significantly greater tumor necrosis at pathology (70% vs. 10%,p= 0.002) and more frequent extended resections. Five-year cancer-specific survival (80.4% vs. 33.5%,p= 0.011), recurrence-free survival (33.8% vs. 14.0%,p= 0.047), and curative-intent disease-free survival (69.3% vs. 18.9%,p= 0.0037) were significantly higher in the TARE group. Overall survival showed a favorable trend. Intraoperative outcomes, postoperative morbidity, and 90-day mortality were comparable between groups.Conclusions: Preoperative TARE is a safe and effective neoadjuvant strategy in selected patients with HCC undergoing major hepatectomy. It may enhance long-term oncological outcomes without increasing surgical risk, supporting its potential role in the management of borderline resectable HCC.
背景/目的：对于需要大范围肝切除的肝细胞癌（HCC），术前治疗策略仍存在争议，尤其是在“临界可切除”病例中。本研究旨在评估钇-90经动脉放射栓塞术（TARE）在接受右半肝或扩大右半肝切除术的HCC患者中的肿瘤学获益及围手术期安全性。 材料与方法：回顾性分析了2013年1月至2023年12月期间，在同一家三级医疗中心连续接受右半肝或扩大右半肝切除术治疗HCC的所有患者。根据是否接受术前TARE或直接手术将患者分组。分析结果包括围手术期并发症和长期肿瘤学终点。 结果：共纳入39例患者，其中18例接受了术前TARE，21例接受了直接手术。TARE组患者在病理学上显示出显著更高的肿瘤坏死率（70% vs. 10%，p=0.002），且接受扩大切除术的比例更高。TARE组的5年癌症特异性生存率（80.4% vs. 33.5%，p=0.011）、无复发生存率（33.8% vs. 14.0%，p=0.047）以及以治愈为目的的无病生存率（69.3% vs. 18.9%，p=0.0037）均显著更高。总生存率也呈现有利趋势。两组在术中结果、术后并发症及90天死亡率方面相当。 结论：对于接受大范围肝切除术的特定HCC患者，术前TARE是一种安全有效的新辅助治疗策略。它可能在不增加手术风险的情况下改善长期肿瘤学结局，支持其在临界可切除HCC治疗中的潜在作用。
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