Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification

Ueno, S.; Kubo, Fumitake; Shimada, Masahiko; Hiwatashi, Kiyokazu; Tateno, Taro; Mataki, Yuko; Maemura, Kosei; Shinchi, Hiroyuki; Natsugoe, Shoji; Aikou, Takashi

doi:10.1007/s00534-007-1312-8

Cited by 124 publications

(96 citation statements)

References 34 publications

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“…However, in a different study, anatomic resection achieved better recurrence-free survival rate in small HCC (≤3 cm) accompanied by three or fewer nodules (44). They also determined that success rate was more prominent in nonboundary type HCC (single nodular type with extranodular growth, confluent multinodular type, and invasive type) than in the boundary type (single nodular type) (44). They also revealed that the distance of micrometastases from the main mass was significantly longer in the nonboundary type (9.5 mm) than in the boundary type (3.1 mm) (44).…”

Section: The Effect Of Microvascular Invasion On Treatment Surgerymentioning

confidence: 87%

“…Nakashima et al (21) and Ueno et al (44) reported that the distance between the micrometastasis and the main tumor was 10 mm or shorter in most of the patients. Thus, it is crucial to ablate the main tumor with an adequate surrounding liver tissue of ≥10 mm to prevent the recurrence and local control of MVI (28, 48).…”

Section: Locoregional Treatmentmentioning

confidence: 95%

“…Additionally, radiofrequency ablation (RFA) achieved comparable three-and five-year overall survival rates with surgical resection in patients with very early stage HCC (≤2 cm), although surgery resulted in better disease-free survival than RFA (43). However, in a different study, anatomic resection achieved better recurrence-free survival rate in small HCC (≤3 cm) accompanied by three or fewer nodules (44). They also determined that success rate was more prominent in nonboundary type HCC (single nodular type with extranodular growth, confluent multinodular type, and invasive type) than in the boundary type (single nodular type) (44).…”

Section: The Effect Of Microvascular Invasion On Treatment Surgerymentioning

confidence: 99%

“…They also determined that success rate was more prominent in nonboundary type HCC (single nodular type with extranodular growth, confluent multinodular type, and invasive type) than in the boundary type (single nodular type) (44). They also revealed that the distance of micrometastases from the main mass was significantly longer in the nonboundary type (9.5 mm) than in the boundary type (3.1 mm) (44). Anatomic resection is more effective in nonboundary type HCC, due to increased risk of MVI and intrahepatic metastasis.…”

Section: The Effect Of Microvascular Invasion On Treatment Surgerymentioning

confidence: 99%

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Microvascular invasion in hepatocellular carcinoma

Ünal

İdilman

Akata³

et al. 2016

Diagn Interv Radiol

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H epatocellular carcinoma (HCC) is responsible for high incidence of cancer-related mortality worldwide (1, 2). Diagnosis of HCC is a well-known topic, and now it can be made solely by imaging findings in cirrhosis (3,4). Advances in imaging procedures and intense follow-up of high-risk patients led to increased early detection of HCC and better treatment options (5, 6). However, even in good surgical candidates, long-term survival rates remain unsatisfactory because of high recurrence (7,8). Presence of microvascular invasion (MVI) has been reported to be one of the most important risk factors related to postsurgery tumor recurrence (9-11). Presence of MVI alters the surgical procedure. MVI is a prognostic factor associated with lower survival and higher recurrence rates. Prediction of MVI may also affect locoregional treatments along with chemotherapy protocols. This review will focus on all aspects of MVI. The effect of microvascular invasion on survivalEarly tumor recurrence is linked to increased mortality rate. Lim et al. (9) reported that MVI is a more prominent tumor recurrence predictor than the Milan criteria for HCC after surgical resection. The patients who fulfill the Milan criteria should have a solitary tumor not exceeding 5 cm or three or fewer tumors with the largest not exceeding 3 cm, and no evidence of macrovascular invasion or extrahepatic metastasis (5, 9). Lim et al. (9) concluded that patients (without MVI) exceeding the Milan criteria could achieve comparable overall survival rates after surgical resection, relative to patients within the Milan criteria. However, overall survival decreased significantly with MVI, independently of the Milan criteria.In a different study, authors grouped the patients into mild (one to five invaded vessels) and severe (more than five invaded vessels) MVI groups (5). They found that the three-year recurrence-free survival rates for patients with and without MVI were 27.7% and 62.5%, respectively. They also reported that recurrence-free survival rates at two years for patients without MVI, with mild MVI, and severe MVI were 75.9%, 47.2%, and 32.7%, respectively (5). Goh et al. (12) studied patients who had surgical resection of multifocal HCC and revealed that the presence of MVI and the number of nodules (which is also a result of MVI) were more important prognostic factors than tumor size (12). They also suggested that the current American Joint Committee for Cancer TNM staging system, which uses tumor size, but not MVI, as prognostic criteria for multifocal HCC, needs to be revised (12). The indicators of microvascular invasionDespite its significance in HCC assessment, MVI can rarely be diagnosed preoperatively. However, the presence of MVI may be predicted by key radiologic findings and specific lab- We reviewed the literature and aimed to draw attention to clinicopathologic and imaging findings that may predict the presence of microvascular invasion in hepatocellular carcinoma. Imaging findings suggesting microvascular invasion are disruption of capsule...

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Section: The Effect Of Microvascular Invasion On Treatment Surgerymentioning

confidence: 87%

Section: Locoregional Treatmentmentioning

confidence: 95%

Section: The Effect Of Microvascular Invasion On Treatment Surgerymentioning

confidence: 99%

Section: The Effect Of Microvascular Invasion On Treatment Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Microvascular invasion in hepatocellular carcinoma

Ünal

İdilman

Akata³

et al. 2016

Diagn Interv Radiol

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show abstract

“…If the HCC is smaller in size, one could reasonably deduce that there would be no statistical difference in the DFS after AS or MH since the risk of dissemination is presumably negligible, which means that both techniques had efficacy equivalent to that of local ablative therapy. If the HCC is larger, most patients will already have macroscopic vascular invasion or satellite nodules that will result in a high incidence of recurrence (14). This means a more advanced stage of HCC and evidence of the oncological behavior of the HCC, potentially offsetting the effects of the technique used.…”

Section: Anatomical Vs Non-anatomical Resectionmentioning

confidence: 99%

Recent advances in surgical treatment of hepatocellular carcinoma

Song

2015

DD&T

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Microvascular invasion of single small hepatocellular carcinoma ≤3 cm: Predictors and optimal treatments

Yamashita

Imai

Yusa

et al. 2018

Annals of Gastroent Surgery

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BackgroundSmall hepatocellular carcinomas (HCC ≤3 cm) are generally considered to have low malignant potential; however, some of them display pathological microvascular invasion (MVI).MethodsBetween 1991 and 2013, 414 patients with a single HCC ≤3 cm underwent curative hepatic resection (HR). Predictors for MVI were identified. Using another cohort (149 patients during 2000‐2014), our predictors for MVI in HCC ≤3 cm were validated. In 428 patients with a single HCC ≤3 cm who had predictors for MVI, survival was compared among anatomical HR (n = 149), partial HR (n = 227), and radiofrequency ablation (RFA) (n = 52).ResultsThe positive rate of MVI reached 40.6% (168/414 patients). Independent predictors for MVI were as follows: tumor diameter ≥2 cm (odds ratio 1.84, P = .0052), alpha‐fetoprotein (AFP) ≥200 ng/mL (odds ratio 1.82, P = .0466), and des‐gamma‐carboxy prothrombin (DCP) ≥40 mAU/mL (odds ratio 1.79, P = .0126). Matching at least one predictor among these three could predict MVI in HCC ≤3 cm well (sensitivity 82.8%, positive predictive value [PPV] 48.7%). This criterion could also predict MVI in HCC ≤3 cm well in another cohort (sensitivity 82.8%, PPV 30.3%). In patients with single HCC ≤3 cm matching our criterion for predicting MVI, anatomical HR led to significantly better survival in both disease‐free (hazard ratio 0.689, P = .0231) and overall (hazard ratio 0.589, P = .0316) survivals.ConclusionMatching at least one factor among three (tumor diameter ≥2 cm, AFP ≥200 ng/mL, or DCP ≥40 mAU/mL) can predict MVI in HCC ≤3 cm. In such patients, anatomical HR would be recommended to improve survival.

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Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification

Cited by 124 publications

References 34 publications

Microvascular invasion in hepatocellular carcinoma

Microvascular invasion in hepatocellular carcinoma

Recent advances in surgical treatment of hepatocellular carcinoma

Microvascular invasion of single small hepatocellular carcinoma ≤3 cm: Predictors and optimal treatments

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