A wide-margin liver resection improves long-term outcomes for patients with HBV-related hepatocellular carcinoma with microvascular invasion

Yang, Pinghua; Si, Anfeng; Yang, Jing; Cheng, Zhangjun; Wang, Kui; Li, Jun; Xia, Yong; Zhang, Baohua; Pawlik, Timothy M.; Lau, Wan Yee; Shen, Feng

doi:10.1016/j.surg.2018.09.016

Cited by 82 publications

(70 citation statements)

References 41 publications

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“…Spearman's rank correlation and stepwise logistic regression analysis suggested that ICG fluorescence navigation was an important correlation factor and predictor of a wide margin. As a wide surgical margin should be a target of resection of malignant liver tumors [24][25][26][27], these results indicated that the patients in the ICG-FN group might have a lower postoperative recurrence rate and longer postoperative survival, although this still needs to be verified by long-term follow-up data.…”

Section: Discussionmentioning

confidence: 89%

“…A meta-analysis of 34 studies involving 11,147 hepatectomy patients concluded that patients with a wide margin (> 10 mm) had a better prognosis, suggesting that this should be one of the goals of hepatectomy [24]. Recent studies also identified that a wide surgical margin is predictive of a better long-term prognosis [25][26][27]. During laparoscopic surgery, the lack of tactile perception of laparoscopic forceps and the 2-dimensional image on the monitor in most centers might affect surgeons' evaluation of the resection range, which could be insufficient to preserve liver parenchyma, resulting in a narrow margin or a positive margin.…”

Section: Discussionmentioning

confidence: 99%

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Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Liang

Qian

et al. 2020

Surg Today

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Purpose To explore the role of indocyanine green (ICG) fluorescence navigation in laparoscopic hepatectomy and investigate if the timing of its administration influences the intraoperative observation. Methods The subjects of this retrospective study were 120 patients who underwent laparoscopic hepatectomy; divided into an ICG-FN group (n = 57) and a non-ICG-FN group (n = 63). We analyzed the baseline data and operative data. Results There were no remarkable differences in baseline data such as demographic characteristics, lesion-related characteristics, and liver function parameters between the groups. Operative time and intraoperative blood loss were significantly lower in the ICG-FN group. The rate of R0 resection of malignant tumors was comparable in the ICG-FN and non-ICG-FN groups, but the wide surgical margin rate was significantly higher in the ICG-FN group. The administration of ICG 0–3 or 4–7 days preoperatively did not affect the intraoperative fluorescence imaging. Operative time, intraoperative blood loss, and a wide surgical margin correlated with ICG fluorescence navigation. ICG fluorescence navigation helped to minimize intraoperative blood loss and achieve a wide surgical margin. Conclusion ICG fluorescence navigation is safe and efficient in laparoscopic hepatectomy. It helps to achieve a wide surgical margin, which could result in a better prognosis. The administration of ICG 0–3 days preoperatively is acceptable.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Liang

Qian

et al. 2020

Surg Today

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“…However, recent studies have found that the long-term survival benefit of patients undergoing ALPPS was significantly better than that of patients undergoing TACE, indicating that ALPPS is a feasible strategy for patients without an insufficient FRLV (16). In addition to this evidence, the 2019 guidelines also note that LR with wide margins results in a better long-term prognosis than narrow resection margins, and this is especially true for patients with microvascular invasion (17,18). In terms of postoperative treatment, the 2019 guidelines more clearly suggest that an antivirus work-up can reduce recurrence after R0 resection is achieved (19).…”

Section: Liver Puncture Biopsymentioning

confidence: 99%

Interpretation of guidelines for the diagnosis and treatment of primary liver cancer (2019 edition) in China

Qiu

Jin

Chen

et al. 2020

GHM

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Primary liver cancer (PLC) is currently the fourth most common malignancy and accounts for the second most cancer-related deaths in China. Since 2017, a great deal of high-level evidence, and particularly evidence based on Chinese studies and practice, has emerged in terms of diagnosis, staging, and treatment. A new version of the guidelines for the management of PLC specifying the diagnosis and treatment of PLC (2019 edition) has recently been published. The guidelines feature major changes in the techniques for early diagnosis, the combination of surgery, local therapy, and systemic treatment, and the use of traditional Chinese medicine. The guidelines need to be further implemented in clinical practice to demonstrate their validity.

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“…Early recurrence accounts for most (approximately 70%) recurrent cases [4], mainly due to postoperative minimal residual disease (MRD) [5,6]. Although a wider surgical margin may prevent early recurrence in HCC patients [7], too wide of a margin may leave insufficient liver parenchyma and lead to liver failure after resection [8]. Balancing operative safety and efficacy is necessary for surgically treating HCC patients.…”

Section: Introductionmentioning

confidence: 99%

Effect of surgical margin on recurrence based on preoperative circulating tumor cell status in hepatocellular carcinoma

Zhou

Sun

et al. 2020

eBioMedicine

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Background High rates of recurrence after resection severely worsen hepatocellular carcinoma (HCC) prognosis. This study aims to explore whether circulating tumor cell (CTC) is helpful in determine the appropriate liver resection margins for HCC patients. Methods HCC patients who underwent liver resection were enrolled into training ( n =117) or validation ( n =192) cohorts, then classified as CTC-positive (CTC≥1) or CTC-negative (CTC=0). A standardized pathologic sampling method was used in the training cohort to quantify microvascular invasion (mVI) and the farthest mVI from the tumor (FMT). Findings CTC number positively correlated with mVI counts ( r =0.655, P <0.001) and FMT ( r =0.495, P <0.001). The CTC-positive group had higher mVI counts ( P =0.032) and greater FMT P =0.008) than the CTC-negative group. In the CTC-positive group, surgical margins of >1 cm independently protected against early recurrence (training cohort, P =0.004; validation cohort, P =0.001) with lower early recurrence rates (training cohort, 20.0% vs. 65.1%, P =0.005; validation cohort, 36.4% vs. 65.1%, P =0.003) compared to surgical margins of ≤1 cm. No differences in postoperative liver function were observed between patients with margins >1 cm vs . ≤1 cm. Surgical margin size minimally impacted early postoperative HCC recurrence in CTC-negative patients when using 0.5 cm or 1 cm as the threshold. Interpretations Preoperative CTC status predicts mVI severity in HCC patients and is a potential factor for determining optimal surgical margin size to ensure disease eradication and conserve liver function. A surgical margin of >1 cm should be achieved for patients with positive CTC. Funding A full list of funding bodies that contributed to this study can be found in the Acknowledgement section.

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A wide-margin liver resection improves long-term outcomes for patients with HBV-related hepatocellular carcinoma with microvascular invasion

Cited by 82 publications

References 41 publications

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Interpretation of guidelines for the diagnosis and treatment of primary liver cancer (2019 edition) in China

Effect of surgical margin on recurrence based on preoperative circulating tumor cell status in hepatocellular carcinoma

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