Ruan GY, Zhu Z, Cai ZZ, Lu GR, Wang QJ. Clinical applicability of synchronous vs sequential transarterial chemoembolization and microwave ablation in hepatocellular carcinoma. World J Gastrointest Surg 2026; 18(9): 119296 [DOI: 10.4240/wjgs.119296]
Corresponding Author of This Article
Qin-Jian Wang, Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Wenzhou 325000, Zhejiang Province, China. 571924277@qq.com
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Gastroenterology & Hepatology
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review-article
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Ruan GY, Zhu Z, Cai ZZ, Lu GR, Wang QJ. Clinical applicability of synchronous vs sequential transarterial chemoembolization and microwave ablation in hepatocellular carcinoma. World J Gastrointest Surg 2026; 18(9): 119296 [DOI: 10.4240/wjgs.119296]
World J Gastrointest Surg. Sep 27, 2026; 18(9): 119296 Published online Sep 27, 2026. doi: 10.4240/wjgs.119296
Clinical applicability of synchronous vs sequential transarterial chemoembolization and microwave ablation in hepatocellular carcinoma
Gao-Yi Ruan, Zheng Zhu, Zhen-Zhai Cai, Guang-Rong Lu, Qin-Jian Wang
Gao-Yi Ruan, Department of Internal Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Zheng Zhu, The Second School of Medicine, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Zhen-Zhai Cai, Guang-Rong Lu, Qin-Jian Wang, Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Co-first authors: Gao-Yi Ruan and Zheng Zhu.
Co-corresponding authors: Guang-Rong Lu and Qin-Jian Wang.
Author contributions: Wang QJ, Ruan GY and Zhu Z contributed to manuscript writing and editing; Ruan GY and Zhu Z contributed equally to this manuscript as co-first authors; Lu GR and Wang QJ contributed equally to this manuscript as co-corresponding authors; Cai ZZ and Lu GR contributed to conceptualization and critical revisions. All authors have read and approved the final manuscript.
AI contribution statement: During the process of writing the manuscript and answering-reviewers document, I only used translation tools like DeepL and did not use AI tools such as ChatGPT. The main body of the paper (abstract, introduction, materials and methods, results, discussion and conclusion) has not been generated using AI tools. Only DeepL was used to translate and polish some sentences, without using AI tools to analyze data or assist in manuscript writing. AI tools were not involved in the design of the research or the interpretation of the results.
Supported by the Natural Science Foundation of Wenzhou City, No. Y20240207.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Qin-Jian Wang, Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Wenzhou 325000, Zhejiang Province, China. 571924277@qq.com
Received: January 26, 2026 Revised: February 1, 2026 Accepted: May 19, 2026 Published online: September 27, 2026 Processing time: 235 Days and 3.9 Hours
Abstract
Hepatocellular carcinoma remains one of the leading causes of cancer-related mortality worldwide, and locoregional therapies play a pivotal role in patients who are not eligible for surgical resection or liver transplantation. Among these, the combination of transarterial chemoembolization and microwave ablation has emerged as a promising therapeutic strategy owing to their complementary mechanisms of action. However, the optimal sequencing of these modalities - whether performed synchronously or sequentially - remains a matter of ongoing debate. Although current evidence suggests comparable short-term efficacy and safety between the two approaches, significant limitations persist, including heterogeneity in patient populations, lack of stratification by tumor burden, and insufficient long-term follow-up. In this opinion review, we critically appraise the existing literature, highlight key controversies, and present our perspective on individualized treatment selection. We emphasize that tumor characteristics, liver function, and procedural considerations should guide clinical decision-making. Finally, we outline future research priorities, including prospective stratified studies, standardized protocols, and integration with systemic therapies.
Core Tip: Combination of transarterial chemoembolization and microwave ablation is an effective locoregional treatment for hepatocellular carcinoma. Synchronous and sequential strategies show similar short-term efficacy and safety, but current evidence is limited by heterogeneity, non-standardized protocols, and insufficient long-term data. Synchronous therapy is suitable for small, solitary tumors with good liver function, whereas sequential therapy is better for large, multifocal tumors or impaired liver reserve. Individualized selection and future prospective, stratified, biomarker-driven studies are needed to optimize clinical practice.
