**4.1 Role of adjuvant regional therapy**

The preventive effect of TACE on recurrence after operation had been studied by prospective (Peng et al., 2009; Zhong et al., 2009) and retrospective series (Ren et al., 2004; Xi et al., 2007) mostly in eastern centers. The survival benefit of adjuvant TACE after hepatic resection was demonstrated in patients with high risk factors for recurrence while the effect in low risk for recurrence remains questionable. However, the quoted high risk factors for recurrence varied between studies, namely large tumor, multiple nodules, vascular invasion and presence of portal vein tumor thrombus. With the currently available evidence, the adjuvant regional chemotherapy with or without embolization or combination of systemic chemotherapy does not provide any additional benefit (Chan et al., 2000; Lau et al., 2009; Schwartz et al., 2002). Adjuvant transarterial treatments with 131I-lipiodol and adjuvant immunotherapy with interferon had demonstrated early promising results, which may have a role in preventing early intra-hepatic recurrence (Boucher et al., 2003; Ikeda et al., 2000; Kudo et al., 2002; Lau et al., 2008; Partensky et al., 2000; Sun et al., 2006; Takjayama et al., 2000). However, its role remains to be confirmed by further studies.
