Hepatic resection compared to chemoembolization in intermediate‐ to advanced‐stage hepatocellular carcinoma: A meta‐analysis of high‐quality studies

Abstract

This meta-analysis suggests that surgical resection provides survival benefits in patients with intermediate- to advanced-stage HCC. The evidence found herein may assist in the choice of treatment modality based on diverse definitions of operability. (Hepatology 2018).

Treatment of Intermediate-Stage Hepatocellular Carcinoma in Japan: Position of Curative Therapies

“…A small difference in size did not affect the procedures and curability of liver resection in many cases. A recent study indicated the survival benefit of liver resection in patients with IM-HCC, which included many large HCC > 5 cm in diameter with a small number [33]. A small increase in the number of tumors did not dramatically increase the risk or reduce the curability of RFA.…”

Surgical Resection Versus Transarterial Chemoembolization for Intermediate Stage Hepatocellular Carcinoma (BCLC‐B): An Unsolved Question

“…We have read the article of Hyun et al with great interest . We commend the authors for this study that tackles a crucial point in the treatment of hepatocellular carcinoma (HCC).…”

Letter to the Editor: Hepatic Resection Compared to Chemoembolization in Intermediate‐ to Advanced‐Stage Hepatocellular Carcinoma: A Comment For Moving Forward

“…The BCLC system recommends only transarterial chemoembolization (TACE) and sorafenib for intermediate and advanced HCC, yet several studies have suggested that expanding the selection criteria for hepatectomy can increase overall survival of these patients. Now, an elegant meta-analysis by Hyun and coworkers (4) suggests that, indeed, based on the evidence in 18 high-quality studies, hepatectomy can increase overall survival in patients with intermediate and advanced HCC.…”

“…In our analysis, three studies used a common database that had partially overlapping patients. (3)(4)(5) Therefore, theoretically, these patients should be investigated separately. However, those studies were performed in multiple centers with various inclusion criteria and enrollment periods, making it difficult to identify identical populations from the published data.…”

“…Moreover, compression by choledochal or periportal varices of the extrahepatic biliary tree from chronic PVT resulting in portal/biliary cholangiopathy may be associated with increased biliary pressure. (4,5) As pointed out by Gioia et al, patients with PVT have associated subtle histological features, such as phleboclerosis, NRH, sinusoidal dilation, and perisinusoidal or perivenular fibrosis, that could potentially increase the LSM. (6) Although these histological features are less common and may not have much clinical relevance, their effect on LSM is something that needs to be appreciated more in future investigations.…”