Alpha-fetoprotein (AFP), des-γ-carboxy prothrombin (DCP), and lens culinaris agglutinin-reactive fraction of AFP (AFP-L3) have been developed with the intent to detect hepatocellular carcinoma (HCC) and for the surveillance of at-risk patients. However, at present, none of these tests can be recommended to survey cirrhotic patients at risk for HCC development because of their suboptimal ability for routine clinical practice in HCC diagnosis. Starting from these considerations, these markers have been therefore routinely and successfully used as predictors of survival and HCC recurrence in patients treated with curative intent. All these markers have been largely used as predictors in patients treated with hepatic resection or locoregional therapies, mainly in Eastern countries. In recent studies, AFP has been proposed as predictor of recurrence after liver transplantation and as selector of patients in the waiting list. Use of AFP modification during the waiting list for LT is still under investigation, potentially representing a very interesting tool for patient selection. The development of a new predictive model combining radiological and biological features based on biological markers is strongly required. New genetic markers are continuously discovered, but they are not already fully available in the clinical practice.

Background Terlipressin, in general, is a vasopressor which acts via V1 receptors. Its infusion elevates mean blood pressure and can reduce bleeding which has a splanchnic origin. The primary outcome was to assess the impact of intraoperative terlipressin infusion on portal venous pressure during hepatobiliary surgery; the 2ry outcomes included effects upon systemic hemodynamics, estimated blood loss, and postoperative renal functions. Methods This prospective randomized study involved 50 patients undergoing hepatobiliary surgery who were randomly and equally allocated into terlipressin group, or a control group. The terlipressin group received an initial bolus dose of (1 mg over 30 min) followed by a continuous infusion of 2 μg/kg/h throughout the procedure and gradually weaned over the first four postoperative hours, whereas the control group received the same volumes of normal saline. The portal venous pressure changes were measured directly through a portal vein angiocatheter. Results Portal pressure was significantly reduced over time in the terlipressin group only (from 17.88 ± 7.32 to 15.96 ± 6.55 mmHg, p < .001). Mean arterial blood pressure was significantly higher in the terlipressin group. Estimated blood loss was significantly higher in the control group than the terlipressin group (1065.7 ± 202 versus 842 ± 145.5 ml; p = 0.004), and the units of packed RBCs transfused were significantly higher in the control group ((0–2) versus (0–4) p = 0.003). There was no significant difference between groups as regards the incidence of acute kidney injury. Conclusion Intraoperative infusion of terlipressin during hepatobiliary surgery was shown to improve intraoperative portal hemodynamics with subsequent reduction in blood loss. Trial registration Clinical trial number and registry URL: Trial registration number: NCT02718599 . Name of registry: ClinicalTrials.gov. URL of registry: https://clinicaltrials.gov/ct2/show/NCT02718599 . Date of registration: March 2016. Date of enrolment of the first participant to the trial: April 2016.

Terlipressin infusion during major liver resection was associated with less bleeding compared to placebo. More studies are required to confirm our results especially in patients with normal portal pressure.

No abstract

Aim This study aims to report our experience with the extra‐hepatic Glissonean approach (EHGA) in liver resection in patients with cirrhosis. Patients and Methods From a prospectively maintained database in Al‐Rajhi Liver Hospital, Assiut University, Egypt, all patients with cirrhosis with hepatocellular carcinoma (HCC) who had open liver resections of two or more segments from January 2014 to December 2016 were identified. As many as 49 patients received resection via the classical pedicle dissection technique (PDT) and 38 by EHGA. Results There was no difference in age, sex, American Society of Anesthesiologists grade, aetiology of liver disease, alpha‐fetoprotein, tumour number, size, Child‐Turcotte‐Pugh or Model for End‐stage Liver Disease scores between groups. Patients in the EHGA group had shorter operative time (214 ± 54 vs. 249 ± 44 minutes in PDT; P = .001), lesser blood loss (647 ± 140 ml vs. 741 ± 192 ml, respectively; P = .010), wider safety margin (14 ± 3.5 mm vs. 11.5 ± 5.8 mm, respectively; P = .029), lesser decompensation (18.4% vs. 40.8%, respectively; P = .026) and shorter hospital stay (8, range 3‐26 vs. 9, range 4‐36 days, respectively; P = .015). There was no 30‐day mortalities in the EHGA group compared with two in the PDT group. There were no differences between groups in 1‐ and 3‐year overall and recurrence‐free survival rates. Conclusions EHGA is a rapid, safe and oncologically sound approach for segmental anatomical liver resections of HCC in patients with cirrhosis.