Impact of Anatomical Resection for Hepatocellular Carcinoma With Microportal Invasion (vp1)

Hidaka, Masaaki; Eguchi, Susumu; Okuda, K; Beppu, Teruhiko; Shirabe, Ken; Kondo, Kazuhiro; Takami, Yuko; Ohta, Masayuki; Shiraishi, Masayuki; Ueno, S.; Nanashima, Atsushi; Noritomi, Tomoaki; Kono, Kenji; Fujioka, Hikaru

doi:10.1097/sla.0000000000002981

Cited by 70 publications

(57 citation statements)

References 20 publications

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“…Theoretically, the utilization of anatomical resection would hinder dissemination of tumor cells throughout portal venous flow into the remnant liver and would be the surgical technique most apt to reduce early recurrence of HCC following resection. In 2018, Hidaka et al published a retrospective analysis of 546 patients with HCC with microportal invasion (vp1), where they found that local recurrence occurred significantly more frequently in the NAR than the AR group [20]. However, this hypothesis has some limitations in explaining early recurrences as it assumes that tumor cells have not already left the tumor into the portal venous system as tumor circulating cells prior to resection.…”

Section: Theoretical Advantages Of Anatomical Resection Surgical Tmentioning

confidence: 99%

The Utility of Anatomical Liver Resection in Hepatocellular Carcinoma: Associated with Improved Outcomes or Lack of Supportive Evidence?

Yopp

2019

Cancers

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Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths worldwide. Surgical resection of HCC remains one of the mainstays of curative therapies and is associated with five-year overall survival rates approaching 60%. Despite improved perioperative outcomes, locoregional recurrence within the first two years following hepatic resection is of significant concern with recurrence rates of up to 50%. The use of anatomical resection surgical approaches, whereby the portal venous blood flow is ligated proximal to the tumor bed, is postulated to reduce recurrence rates due to reduction of micrometastatic disease. The aim of this review is to characterize the definition of an anatomical resection (AR) during partial hepatectomy, discuss the theoretical advantages of AR during hepatic resection for HCC, and to present evidence of the impact of AR on outcome measures in patients with HCC. Based on current data, there is a lack of conclusive evidence to support the universal use of AR in cirrhotic patients with HCC. A randomized clinical trial is warranted to further clarify the debate between AR versus non-anatomical resection (NAR) for HCC.

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Section: Theoretical Advantages Of Anatomical Resection Surgical Tmentioning

confidence: 99%

The Utility of Anatomical Liver Resection in Hepatocellular Carcinoma: Associated with Improved Outcomes or Lack of Supportive Evidence?

Yopp

2019

Cancers

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“…When Professor Makuuchi determined the definition of anatomical hepatectomy, he believed that a gross resection of the tumor-bearing liver removes not only the tumor visible to the naked eye but also microvascular invasion that is difficult to detect (30), which has been affirmed by many studies and is also consistent with the findings of our study. Also, some researchers revealed that AR or NAR for HCC with MVI did not influence the recurrence-free survival or OS rates after hepatectomy in the modern era (16).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, it has been reported that anatomical resection (AR) of the liver can be useful in isolating microvascular metastases while removing lesions (14,15). However, multicenter retrospective studies revealed no significant difference between AR and non-anatomical resection (NAR) in terms of tumor-free survival and long-term survival post-operatively (16). In the current study, we aim to establish a valid prediction model to prognose the occurrence of microvascular invasion, and apply this model to compare the efficacy of AR or NAR in the treatment of patients retrospectively.…”

Section: Importance Of Microvascular Invasion Risk and Tumor Size On mentioning

confidence: 99%

Importance of Microvascular Invasion Risk and Tumor Size on Recurrence and Survival of Hepatocellular Carcinoma After Anatomical Resection and Non-anatomical Resection

Zeng

et al. 2021

Front. Oncol.

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Purpose: To establish a valid prediction model to prognose the occurrence of microvascular invasion (MVI), and to compare the efficacy of anatomic resection (AR) or non-anatomic resection (NAR) for hepatocellular carcinoma (HCC).Methods: Two hundred twenty-eight patients with HCC who underwent surgical treatment were enrolled. Their hematological indicators, MRI imaging features, and outcome data were acquired.Result: In the multivariable analysis, alpha-fetoprotein >15 ng/mL, neutrophil to lymphocyte ratio >3.8, corona enhancement, and peritumoral hypointensity on hepatobiliary phase were associated with MVI. According on these factors, the AUROC of the predictive model in the primary and validation cohorts was 0.884 (95% CI: 0.829, 0.938) and 0.899 (95% CI: 0.821, 0.967), respectively. Patients with high risk of MVI or those with low risk of MVI but tumor size >5 cm in the AR group were associated with a lower rate of recurrence and death than patients in the NAR group; however, when patients are in the state of low-risk MVI with tumor size >5 cm, there is no difference in the rate of recurrence and death between AR and NAR.Conclusion: Our predictive model for HCC with MVI is convenient and accurate. Patients with high-risk of MVI or low-risk of MVI but tumor size >5 cm executing AR is of great necessity.

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“…It has been documented that preoperative blood AFP level, number of tumors, and diameter of tumor are risk factors for predicting prognosis of patients [ 12 , 14 , 22 , 23 ]. Blood AFP level might be positively related to the diameter of tumor in HCC patients, and the presence of tumor enlargement is a predictive factor for poor prognosis [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Establishment, validation and evaluation of predictive model for early relapse after R0 resection in hepatocellular carcinoma patients with microvascular invasion

et al. 2021

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Backgrounds This is the first study to build and evaluate a predictive model for early relapse after R0 resection in hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI). Methods The consecutive HCC patients with MVI who underwent hepatectomy in Cancer Hospital of Chinese Academy of Medical Science from Jan 2014 to June 2019 were retrospectively enrolled and randomly allocated into a derivation (N = 286) and validation cohort (N = 120) in a ratio of 7:3. Cox regression and Logistic regression analyses were performed and a predictive model for postoperative early-relapse were developed. Results A total of 406 HCC patients with MVI were included in our work. Preoperative blood alpha-fetoprotein (AFP) level, hepatitis B e antigen (HBeAg) status, MVI classification, largest tumor diameter, the status of serosal invasion, number of tumors, and the status of satellite nodules were incorporated to construct a model. The concordance index (C-index) was 0.737 and 0.736 in the derivation and validation cohort, respectively. The calibration curves showed a good agreement between actual observation and nomogram prediction. The C-index of the nomogram was obviously higher than those of the two traditional HCC staging systems. Conclusion We have developed and validated a prediction model for postoperative early-relapse in HCC patient with MVI after R0 resection.

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Impact of Anatomical Resection for Hepatocellular Carcinoma With Microportal Invasion (vp1)

Abstract: Although local recurrence around the resection site was suppressed by AR, AR for HCC with vp1 did not influence the RFS or OS rates after hepatectomy in the modern era.

Cited by 70 publications

References 20 publications

The Utility of Anatomical Liver Resection in Hepatocellular Carcinoma: Associated with Improved Outcomes or Lack of Supportive Evidence?

The Utility of Anatomical Liver Resection in Hepatocellular Carcinoma: Associated with Improved Outcomes or Lack of Supportive Evidence?

Importance of Microvascular Invasion Risk and Tumor Size on Recurrence and Survival of Hepatocellular Carcinoma After Anatomical Resection and Non-anatomical Resection

Establishment, validation and evaluation of predictive model for early relapse after R0 resection in hepatocellular carcinoma patients with microvascular invasion

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