OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of TACE combined with 125I seeds (TACE-125I) in the treatment of recurrent HCC at complex sites after hepatectomy. METHODS: This study retrospectively analyzed the clinical data of recurrent HCC patients located at complex sites (such as large blood vessels, diaphragm dome, etc.) after hepatectomy from January 2012 to December 2023, all of whom received TACE-125I or TACE therapy. Recur rence, overall survival (OS), progression-free survival (PFS) and complications were compared be tween the 2 groups. RESULTS: A total of 152 patients with recurrent HCC were enrolled in this study, including 69 in the TACE-125I group and 83 in the TACE group. During follow-up, a total of 41 patients in the TACE-125I group experienced tumor recurrence, compared to 67 patients in the TACE group. The median OS in the TACE-125I group was 31 months, which was significantly higher than that in the TACE group (16 months, p <
0.002). Similarly, the median PFS was significantly higher in the TACE-125I group than in the TACE group. CONCLUSIONS: Compared with TACE treatment, TACE-125I may be a more effective method for the treatment of recurrent HCC located at complex sites.