Background Preoperative transcatheter arterial embolization (TACE) is conducive to improve the surgery rate and prognosis of hepatocellular carcinoma (HCC) patients. This study aimed to evaluate the reasons and treatment effects of preoperative TACE as well as its influence on the surgery outcome.Method A total of 22 HCC patients (aged 36–68) undergoing TACE sequential surgery were retrospectively reviewed in our centers between January 2018 and August 2020. The parameters reasons, response of

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... umor to TACE, objective remission rate (ORR) and disease control rate (DCR), downstaging rate, abdominal adhesion and arterial injury were statistically analyzed.Results The reasons of preoperative TACE included downstaging (45.5%, 10/22), bridging therapy (22.7%, 5/22), individual choice (13.7%, 3/22), definite diagnosis (9.1%, 2/22), control of liver tumor bleeding (4.5%, 1/22) and patients with cerebral infarction (4.5%,1/22). A total of 6 complete response (CR) cases (27.3%) and 2 pathological CR (PCR) cases (9.1%) were noted. The ORR was 63.6% (14 / 22) and the DCR 90.9 % (20/22). The success rate of downstaging was 50.0% (6/12) in the patients not aiming at downstaging and 10% (1 /10) in the patients aiming at downstaging. The incidences of abdominal adhesion and arterial injury were 90.9% (20/22) and 45.5% (5/11). Conclusion TACE can be used in preoperative conversion therapy for patients who are temporarily unsuitable for surgery and is more suitable for bridging therapy in liver transplantation patients compared with downstaging due to the high DCR. Surgery should be carried out following TACE even in patients with CR.