Preoperative Radioembolization Compared with Chemoembolization or Immediate Resection for Resectable Hepatocellular Carcinoma Outside the Milan Criteria

By
Jeayeon Park
Gyung Sun Lim
Yunmi Ko
Hyunjae Shin
Moon Haeng Hur
Su Young Hong
Suk Kyun Hong
Yun Bin Lee
Eun Ju Cho
Jeong-Hoon Lee
YoungRok Choi
Su Jong Yu
Hyo-Cheol Kim
Kwang-Woong Lee
Jung-Hwan Yoon
Kyung-Suk Suh
Jin Wook Chung
Yoon Jun Kim
October 7, 2026

European Radiology

Objective:

To evaluate preoperative transarterial radioembolization (TARE) and chemoembolization (TACE) compared with immediate liver resection in patients with technically resectable HCC beyond the Milan criteria.

Approach:

Design and setting: Retrospective review of consecutive patients treated at Seoul National University Hospital from January 2016 through July 2024.
Eligibility: Adults with resectable HCC beyond the Milan criteria, Child–Pugh class A liver function, ECOG performance status 0–1, acceptable operative risk, and adequate future liver remnant were included.
Treatment groups: Patients received primary resection or preoperative TACE or TARE, selected by a multidisciplinary tumor board. All patients were technically resectable at baseline and underwent liver resection; transarterial treatment was considered neoadjuvant, not downstagi…
Procedures: TARE used yttrium-90 glass or resin microspheres after angiographic and 99mTc-MAA planning. TACE was conventional or drug-eluting bead TACE, performed superselectively under cone-beam CT guidance.

Interpretation:

The provided context describes the study rationale, eligibility, and treatment methods but does not report comparative outcomes or results.

Limitations:

The retrospective, single-center design is described.
Treatment selection was based on tumor burden, liver function, technical resectability, and physician discretion, allowing potential selection differences between groups.