Hepatectomy for hepatocellular carcinoma larger than 10 cm: preoperative risk stratification to prevent futile surgery

Abstract

According to the present data, among patients submitted to hepatectomy for huge HCC, those with a high bilirubin level, low platelet count and portal vein thrombosis are at higher risk for futile surgery. The presence of portal vein tumour thrombosis should be regarded as a relative contraindication to surgery.

Significance of neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio and prognostic nutrition index as preoperative predictors of early mortality after liver resection for huge (≥10 cm) hepatocellular carcinoma

“…The results of this study confirm that selected patients who undergo LR for huge HCC may enjoy a reasonable 5‐year actuarial overall survival rate of 43%. This is similar or slightly superior to the survival rates reported by several recent studies from both Eastern and Western countries . Although LR for huge HCC is associated with poorer outcomes compared to LR for smaller tumors, it remains the best treatment option for this group of patients as it provides the best survival outcomes compared to other modalities such as transarterial embolization .…”

“…Presently, patients with huge (≥10 cm) HCC have very limited treatment options and LR is the only potentially curative modality, which offers the best survival outcomes . However, LR is only feasible in highly selected patients with an acceptable operative risk and an adequate functional liver remnant . Nonetheless, disease recurrence rates remain high and long‐term survival rates remain modest in most patients after LR .…”

“…However, LR is only feasible in highly selected patients with an acceptable operative risk and an adequate functional liver remnant . Nonetheless, disease recurrence rates remain high and long‐term survival rates remain modest in most patients after LR . Appropriate selection of patients with huge HCC for LR is especially important to prevent “futile surgery” due to the increased operative risk and high frequency of early disease recurrence, which result in early disease‐related mortality .…”

“…Nonetheless, disease recurrence rates remain high and long‐term survival rates remain modest in most patients after LR . Appropriate selection of patients with huge HCC for LR is especially important to prevent “futile surgery” due to the increased operative risk and high frequency of early disease recurrence, which result in early disease‐related mortality . Although prognostic factors after LR for huge HCC have been well‐studied and reported , most of these factors, which have been previously identified, such as microvascular invasion, satellite nodules, and tumor differentiation, are postoperative factors, which are not useful for preoperative decision‐making.…”

“…A recent bi‐institution study from France attempted to identify preoperative predictors of futile surgery for huge HCC defined as perioperative death within 3 months of surgery or death from disease recurrence within 1 year from surgery. They reported a high 3‐month mortality of 18.1% and found that a high bilirubin level and low platelet count predicted 3‐month mortality.…”