Anatomic Resection for Hepatocellular Carcinoma: Prognostic Impact Assessed from Recurrence Treatment

Minagawa, Masaaki; Mise, Yoshihiro; Omichi, Kiyohiko; Ishikawa, Hirofumi; Mizuno, Tomoya; Yoshioka, Ryuji; Imamura, Hiroshi; Yanagisawa, Naotake; Inoue, Yosuke; Takahashi, Yu; Saiura, Akio

doi:10.1245/s10434-021-10380-9

Cited by 20 publications

(22 citation statements)

References 38 publications

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“…interventional failure and overall survival between the two groups [16]. Thus, the AR surgical technique is more effective than NAR.…”

Section: Plos Onementioning

confidence: 79%

“…The most recent studies have shown that AR results in decreased recurrence after the initial hepatectomy. An assessment of recurrence mode and treatment for the recurrence showed that aggressive interventions with curative intent were performed more frequently for intrahepatic recurrence in the NAR group compared to the AR group (42% vs. 10%, P <0.001), which led to comparable time-to-interventional failure and overall survival between the two groups [ 16 ]. Thus, the AR surgical technique is more effective than NAR.…”

Section: Discussionmentioning

confidence: 99%

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Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Cheng

Wang²,

Liu³

et al. 2022

PLoS ONE

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Background Laparoscopic hepatectomy (LH) has achieved rapid progress over the last decade. However, it is still challenging to apply laparoscopy to lesions located in segments I, VII, VIII, and IVa and the hepatic hilar region due to difficulty operating around complex anatomical structures. In this study, we applied three-dimensional printing (3DP) and indocyanine green (ICG) fluorescence imaging technology to complex laparoscopic hepatectomy (CLH) to explore the effects and value of the modified procedure. Materials and methods From January 2019 to January 2021, 54 patients with complex hepatobiliary diseases underwent LH at our center. Clinical data were collected from these patients and retrospectively analyzed. Results A total of 30 patients underwent CLH using the conventional approach, whereas 24 cases received CLH with 3DP technology and ICG fluorescent navigation. Preoperative data were compared between the two groups. In the 3DP group, we modified the surgical strategy of four patients (4/24, 16.7%) due to real-time intraoperative navigation with 3DP and ICG fluorescent imaging technology. We did not modify the surgical strategy for any patient in the non-3DP group (P = 0.02). There were no significant differences between the non-3DP and 3DP groups regarding operating time (297.7±104.1 min vs. 328.8±110.9 min, P = 0.15), estimated blood loss (400±263.8 ml vs. 345.8±356.1 ml, P = 0.52), rate of conversion to laparotomy (3/30 vs. 2/24, P = 0.79), or pathological outcomes including the incidence of microscopical R0 margins (28/30 vs. 24/24, P = 0.57). Additionally, there were no significant differences in postoperative complications or recovery conditions between the two groups. No instances of 30- or 90-day mortality were observed. Conclusion The optimal surgical strategy for CLH can be chosen with the help of 3DP technology and ICG fluorescent navigation. This modified procedure is both safe and effective, but without improvement of intraoperative and short-term outcomes.

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“…interventional failure and overall survival between the two groups [16]. Thus, the AR surgical technique is more effective than NAR.…”

Section: Plos Onementioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Cheng

Wang²,

Liu³

et al. 2022

PLoS ONE

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“…A total of 3 studies [ 11 , 12 , 14 ] reported intrahepatic recurrence rates and 2 studies reported [ 11 , 14 ] extrahepatic metastasis rates, and the results of the heterogeneity test, performed using REM, showed that there was heterogeneity among studies ( P = 0.007, I 2 = 80%). Sensitivity analysis did not significantly change the results.…”

Section: Resultsmentioning

confidence: 99%

“…However, controversies centered on the oncological outcomes of AR and NAR for HCC have been ongoing since several years. Some scholars have argued that AR maximizes tumor resection and improves postoperative survival and thus prefer AR [7][8][9][10][11][12][13]. Others argue that there is no difference in postoperative survival after the two procedures [14].…”

Section: Introductionmentioning

confidence: 99%

Oncological outcomes of anatomic versus non-anatomic resections for small hepatocellular carcinoma: systematic review and meta-analysis of propensity-score matched studies

et al. 2022

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Background Primary liver cancer is the second-most commonly occurring cancer and has resulted in numerous deaths worldwide. Hepatic resection is of two main types, i.e., anatomic resection (AR) and non-anatomic resection (NAR). The oncological outcomes of hepatocellular carcinoma (HCC) patients after AR and NAR are still considered controversial. Therefore, we aimed to compare the impact of AR and NAR on the oncological outcomes of HCC patients with tumor diameters ≤ 5 cm using the propensity score matching method and research-based evidence. Method A systematic literature search was conducted. The main outcomes were disease-free survival (DFS), overall survival (OS), intrahepatic recurrence rate, and extrahepatic metastasis rate. Relative risk (RR) was calculated from forest plots and outcomes using random-effects model (REM). Result AR significantly improved DFS at 1, 3. and 5 years after surgery, compared to NAR (RR = 1.09, 95% CI = 1.04–1.15, P = 0.0003; RR = 1.16, 95% CI = 1.07–1.27, P = 0.0005; RR = 1.29, 95% CI = 1.07–1.55, P = 0.008). However, both of the difference in DFS at 7 years and OS at 1 and 3 years after AR versus that after NAR were not statistically significant. Nevertheless, the long-term OS associated with AR (5, 7, and 10 years) was superior to that associated with NAR (RR = 1.12, 95% CI = 1.03–1.21, P = 0.01; RR = 1.19, 95% CI = 1.04–1.36, P = 0.01; RR = 1.18, 95% CI = 1.05–1.34, P = 0.008). The difference in the intrahepatic recurrence rate after AR versus that after NAR was not statistically significant, but the extrahepatic metastasis rate after AR was significantly lower than that observed after NAR (RR = 0.61, 95% CI = 0.40–0.94, P = 0.03). Conclusion Therefore, AR should be the preferred surgical approach for HCC patients with tumor diameters ≤ 5 cm. Trial registration PROSPERO registration number CRD42022330596.

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“…However, several retrospective studies have reported an improvement in the long-term survival rate of AR compared with NAR. [47][48][49][50][51] The NAR group usually includes patients with severe liver disease; hence, the expected survival time is low, affecting the outcome. Among the six propensity score analyses that have been published, three have reported better results after AR than those with NAR.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Preoperative Serum AFP, CEA, and CA19-9 Levels in Patients with Single Small Hepatocellular Carcinoma: Retrospective Study

Gan¹,

Ren²,

Lang³

et al. 2022

JHC

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Purpose This study aimed to explore the relationship between the tumor marker score (TMS) and the postoperative recurrence of single small hepatocellular carcinoma (HCC). Patients and Methods A total of 409 patients with one resectable HCC with a diameter of 3 cm or less who visited Tianjin Medical University Cancer Institute & Hospital from January 2010 to December 2014 were included in this study. Their alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) levels were classified into low and high groups using X-tile software. Each patients' TMS was calculated as the sum of each tumor marker (low = 0; high = 1). Results A total of 142 patients were classified as TMS0, 171 as TMS1, and 96 as TMS2. Kaplan–Meier analysis illustrated that TMS could divide the patients into groups with remarkably different prognoses, and the patients with high TMS had worse recurrence-free survival (RFS) than those with low TMS. Multivariate analysis showed that TMS, age, and HBeAg positive were the independent predictors of RFS rate. Subgroup analysis revealed that high TMS was a stable risk factor relative to TMS0. Receiver operating curves showed that the 1-, 3-, and 5-year area under curve (AUC) values of TMS were 0.698, 0.662, and 0.673, respectively. The AUC of TMS was higher than that of other common prognostic models in time-dependent receiver operating curve. Conclusion TMS was an independent prognostic factor for the postoperative recurrence of a single small HCC and can provide a well-discriminated risk stratification, thus contributing to prognostic prediction and adjuvant therapeutic development.

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Anatomic Resection for Hepatocellular Carcinoma: Prognostic Impact Assessed from Recurrence Treatment

Cited by 20 publications

References 38 publications

Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Oncological outcomes of anatomic versus non-anatomic resections for small hepatocellular carcinoma: systematic review and meta-analysis of propensity-score matched studies

Predictive Value of Preoperative Serum AFP, CEA, and CA19-9 Levels in Patients with Single Small Hepatocellular Carcinoma: Retrospective Study

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