Aggressive Management of Patients with Extrahepatic and Intrahepatic Recurrences of Hepatocellular Carcinoma by Combined Resection and Locoregional Therapy1

Poon, Ronnie Tung‐Ping; Fan, Sheung‐Tat; Ó'Súilleabháin, Críostóir; Wong, John

doi:10.1016/s1072-7515(02)01226-7

Cited by 106 publications

(93 citation statements)

References 26 publications

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“…A recent study demonstrated that resection of an isolated extrahepatic recurrence might offer long-term survival. 8 Furthermore, like other studies, our results clearly show that surgical treatment of recurrence of HCC can be done safely, just as with the first resection of primary HCC.…”

Section: Treatment Of Extrahepatic Recurrencesupporting

confidence: 85%

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Treatment of tumour recurrence after resection of hepatocellular carcinoma. Analysis of 97 consecutive patients

Tralhão

Dagher

lino

et al. 2007

European Journal of Surgical Oncology (EJSO)

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Objective: To evaluate the long-term results of aggressive treatment of HCC recurrence. Methods: Two hundred and nine consecutive patients underwent hepatic resection for HCC in our hospital. Tumour recurrence was diagnosed in 97 (51%) of the 190 patients with curative resection. Sixteen underwent hepatic resection: two right hepatectomies, one threesegmentectomy, one left hepatectomy, five two-segmentectomies, six segmental resections and one subsegmentectomy. Two patients with metastasis in the spine were submitted to a vertebral body resection. Twenty-five patients were treated with percutaneous ethanol injection or intra-arterial chemoembolization. Fifty-four patients with a poor performance status and liver function or multiple extra hepatic recurrences did not receive any treatment. Results: There were no operative deaths. The postoperative mortality rate was 5.5% (one patient). The cumulative overall survival after the second resection was respectively 89%, 46% and 31% at 1, 3 and 5 years. There was a significant difference in survival between patients treated with repeat resection and those submitted to a non-surgical or conservative treatment ( p < 0.0001). There were no differences in operative deaths, postoperative mortality and morbidity between the first and second hepatic resection. Conclusions: Aggressive management with combined resection or loco regional therapy for intrahepatic recurrence and resection of isolated extra-hepatic recurrence may offer long-term survival in selected patients. Second liver resection for recurrence of HCC can be safely performed.

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Section: Treatment Of Extrahepatic Recurrencesupporting

confidence: 85%

“…PEI or RF can be complementary to surgery. 8,27,28 This encourages an aggressive therapeutic policy, whether surgical or non-surgical, in patients with HCC recurrence after hepatic resection.…”

Section: Treatment Of Hepatic Recurrencementioning

confidence: 99%

Treatment of tumour recurrence after resection of hepatocellular carcinoma. Analysis of 97 consecutive patients

Tralhão

Dagher

lino

et al. 2007

European Journal of Surgical Oncology (EJSO)

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“…Our current analyses indicated that resection of metastatic lesions produced a satisfactory local response, consistent with previous reports. [32][33][34][35][36] Locoregional therapy for extrahepatic metastasis also was discussed in earlier studies, including irradiation for bone, 37 lymph node, 38 brain, 39 and adrenal 40 metastases; TACE for adrenal metastasis 41 ; and percutaneous ablation for adrenal 42 and bone metastases. 43 We also used these methods to treat some patients in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma with extrahepatic metastasis

Uchino

Tateishi

Shiina

et al. 2011

Cancer

383

322

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BACKGROUND: Despite significant advances in the treatment of intrahepatic lesions, the prognosis for patients with hepatocellular carcinoma (HCC) who have extrahepatic metastasis remains poor. The objective of this study was to further elucidate the clinical course and prognostic determinants of patients with this disease. METHODS: In total, 342 patients who had HCC with extrahepatic metastasis were enrolled. The metastases were diagnosed at initial presentation with HCC in 28 patients and during follow-up in the remaining patients. The authors analyzed clinical features, prognoses, and treatments and established a scoring system to predict prognosis using a split-sample method with a testing set and a training set. RESULTS: The most frequent site of extrahepatic metastasis was the lung followed by lymph nodes, bone, and adrenal glands. These metastases were related directly to death in only 23 patients (7.6%). The median survival after diagnosis of extrahepatic metastasis was 8.1 months (range, 0.03-108.7 months). In univariate analysis of the training set (n ¼ 171), performance status, Child-Pugh classification, the number and size of intrahepatic lesions, macroscopic vascular invasion, symptomatic extrahepatic metastases, a-fetoprotein levels, and complete responses to treatment were associated significantly with prognosis. On the basis of multivariate analysis, a scoring system was developed to predict prognosis that assessed uncontrollable intrahepatic lesions, extent of vascular invasion, and performance status. This scoring system was validated in the testing set (n ¼ 171) and produced a concordance index of 0.73. CONCLUSIONS: The controllability of intrahepatic lesions and performance status were identified as important prognostic factors in patients with advanced HCC who had extrahepatic metastasis. Cancer 2011;117:4475-

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“…TACE might in a few cases downstage the tumor size making it resectable [106] . In general, multimodal therapy for recurrent liver tumors (TACE, local ablation and re-resection) can result in a prolonged 5-year survival rate of up to 20% [20][21][22][23] . New techniques have been suggested to target malignant liver tumors without retarding the capability of liver regeneration.…”

Section: Trendsmentioning

confidence: 99%

“…Modern surgical techniques and chemotherapy can improve the five-year survival rate for selected patients with CLM, but intrahepatic recurrence after liver resection occurs in 40%-60% of patients, usually within 12-18 mo postoperatively [18,19] . Although some patients may benefit from more aggressive approaches when recurrence is still observed in the liver, this is generally associated with a poor outcome in most of cases owing to multi-centricity or inadequate functional liver reserve if a resection were to be attempted [20][21][22][23] . The high frequency of tumor recurrence following liver surgery is still a significant clinical problem impairing the long-term survival.…”

Section: Introductionmentioning

confidence: 99%

Effect of liver regeneration on malignant hepatic tumors

Shi

Line

2014

WJG

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Liver regeneration after major surgery may activate occult micrometastases and facilitate tumor growth, leading to liver tumor recurrence. Molecular changes during liver regeneration can provide a microenvironment that stimulates intrahepatic tumor propagation through alterations in cellular signaling pathways, where activation and proliferation of mature hepatocytes, hepatic progenitor cells, non-parenchymal liver cells might favor both liver regeneration and tumor growth. This review highlights recent advances of tumor growth and development in the regenerating liver, possible mechanisms and clinical implications. Key words: Hepatocellular carcinoma; Colorectal cancer; Recurrence; Liver regeneration; Hepatic progenitor cell; Epithelial to mesenchymal transition Core tip: The liver has a unique capacity for regeneration after cellular damage or partial removal of tissue, and modern liver surgery relies on this property. Liver regeneration is a complex process involving a large array of growth factors, cytokines and cells to restore hepatic mass and function. Experimental and clinical data indicate that the regeneration signals facilitate the growth of both primary and secondary liver tumors and can alter their malignant potential. This is an important mechanism underlying recurrence after liver surgery. New therapeutic strategies founded on better insight into the relationship between liver regeneration and tumor biology are needed.Shi JH, Line PD. Effect of liver regeneration on malignant hepatic tumors.

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Aggressive Management of Patients with Extrahepatic and Intrahepatic Recurrences of Hepatocellular Carcinoma by Combined Resection and Locoregional Therapy1

Cited by 106 publications

References 26 publications

Treatment of tumour recurrence after resection of hepatocellular carcinoma. Analysis of 97 consecutive patients

Treatment of tumour recurrence after resection of hepatocellular carcinoma. Analysis of 97 consecutive patients

Hepatocellular carcinoma with extrahepatic metastasis

Effect of liver regeneration on malignant hepatic tumors

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