Hepatic Resection Is Associated With Improved Long-Term Survival Compared to Radio-Frequency Ablation in Patients With Multifocal Hepatocellular Carcinoma

Objectives Thermal ablation (TA) is an established treatment for early HCC. There is a lack of data on the efficacy of repeated TA for recurrent HCC, resulting in uncertainty whether good oncologic outcomes can be obtained without performing orthotopic liver transplantation (OLTx). This study analyses outcomes after TA, with a special focus on repeat TA for recurrent HCC, either as a stand-alone therapy, or in relationship with OLTx. Methods Data from a prospectively registered database on interventions for HCC in a tertiary hepatobiliary centre was completed with follow-up until December 2020. Outcomes studied were rate of recurrence after primary TA and after its repeat interventions, the occurrence of untreatable recurrence, OS and DSS after primary and repeat TA, and complications after TA. In cohorts matched for confounders, OSS and DSS were compared after TA with and without the intention to perform OLTx. Results After TA, 100 patients (56·8%) developed recurrent HCC, of whom 76 (76·0%) underwent up to four repeat interventions. During follow-up, 76·7% of patients never developed a recurrence unamenable to repeat TA or OLTx. OS was comparable after primary TA and repeat TA. In matched cohorts, OS and DSS were comparable after TA with and without the intention to perform OLTx. Conclusions We found TA to be an effective and repeatable therapy for primary and recurrent HCC. Most recurrences can be treated with curative intent. There are patients who do well with TA alone without ever undergoing OLTx. Key Points • Recurrent HCC after primary TA can often be treated effectively with repeat TA. Survival after repeat TA is comparable to primary TA. • In matched cohorts, outcomes after TA with and without subsequent waitlisting for OLTx are comparable. • There are patients who do well for many years with primary and repeat TA alone; some despite multiple recurrences.

show abstract

“…Unfortunately, few studies report DSS. Our 5-year DSS of 73.8% after TA is high compared to the literature [22,23].…”

Section: Discussioncontrasting

confidence: 52%

Outcomes after primary and repeat thermal ablation of hepatocellular carcinoma with or without liver transplantation

et al. 2022

View full text Add to dashboard Cite

show abstract

“…For multiple tumors, surgical treatment may be limited in its indication. As recent reports have shown that liver resection was more effective than non-surgical treatment for ≤3 tumors, [335][336][337] hepatic resection can be considered even for multiple liver tumors that are ≤3 in number and not indicated for LT. With the development of surgical techniques and improvement in patient management, even elderly patients have shown similar short-term and long-term results after hepatic resection as in other age groups, whereas major hepatic resection should still be performed with caution due to the decreased regenerative capacity of the liver in elderly patients. [338][339][340] Although the long-term outcome of ruptured HCC is inferior to that of unruptured HCC, [341][342][343] patients who received hepatic resection after emergency transarterial embolization for hemostasis revealed better survival rates compared to those who only underwent TACE.…”

Section: Indication Of Hepatic Resectionmentioning

confidence: 99%

2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

2022

Clin Mol Hepatol

167

View full text Add to dashboard Cite

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the fourth most common cancer among men in South Korea, where the prevalence of chronic hepatitis B infection is high in middle and old age. The current practice guidelines will provide useful and sensible advice for the clinical management of patients with HCC. A total of 49 experts in the fields of hepatology, oncology, surgery, radiology, and radiation oncology from the Korean Liver Cancer Association-National Cancer Center Korea Practice Guideline Revision Committee revised the 2018 Korean guidelines and developed new recommendations that integrate the most up-to-date research findings and expert opinions. These guidelines provide useful information and direction for all clinicians, trainees, and researchers in the diagnosis and treatment of HCC.

show abstract

“…For multiple tumors, surgical treatment may be limited in its indication. As recent reports have shown that liver resection was more effective than non-surgical treatment for ≤3 tumors, [335][336][337] hepatic resection can be considered even for multiple liver tumors that are ≤3 in number and not indicated for LT. With the development of surgical techniques and improvement in patient management, even elderly patients have shown similar short-term and long-term results after http://e-jlc.org hepatic resection as in other age groups, whereas major hepatic resection should still be performed with caution due to the decreased regenerative capacity of the liver in elderly patients. [338][339][340] Although the long-term outcome of ruptured HCC is inferior to that of unruptured HCC, [341][342][343] patients who received hepatic resection after emergency transarterial embolization for hemostasis revealed better survival rates compared to those who only underwent TACE.…”

Section: Indication Of Hepatic Resectionmentioning

confidence: 99%

2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

2023

JLC

View full text Add to dashboard Cite

dance of new research findings and therapies for HCC have been presented and published in South Korea and around the globe. As many studies have been conducted, a substantial amount of knowledge have been accumulated on the diagnosis, staging, and treatment of HCC specific to Asia, with the study results showing different clinical behaviors from the West, especially in South Korea; these new research find- KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinomaKorean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea*

show abstract

Hepatic Resection Is Associated With Improved Long-Term Survival Compared to Radio-Frequency Ablation in Patients With Multifocal Hepatocellular Carcinoma

Cited by 12 publications

References 35 publications

Outcomes after primary and repeat thermal ablation of hepatocellular carcinoma with or without liver transplantation

Outcomes after primary and repeat thermal ablation of hepatocellular carcinoma with or without liver transplantation

2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

Contact Info

Product

Resources

About