Is Liver Resection Justified in Advanced Hepatocellular Carcinoma? Results of an Observational Study in 464 Patients

Ruzzenente, Andrea; Capra, Franco; Pachera, Silvia; Iacono, Calogero; Piccirillo, Gianluca; Lunardi, Marta; Pistoso, S.; Valdegamberi, Alessandro; D’Onofrio, Mirko; Guglielmi, Alfredo

doi:10.1007/s11605-009-0903-x

Cited by 70 publications

(55 citation statements)

References 22 publications

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“…Although the guidelines EASLD (European Association for the study of Liver Disease), and AASLD (American Association for the study of Liver Disease)(10,40) do not recommend LR for stage B/C, many authors proposed that LR can be safely performed in these patients (41)(42)(43)(44).…”

Section: Resultsmentioning

confidence: 99%

Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center

Grigorie¹,

Alexandrescu²,

Smira³

et al. 2017

chr

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RezumatObiectivul acestui studiu este acela de a evalua rezultatele pacienţilor trataţi pentru hepatocarcinom (CHC) într-un centru de Chirurgie Generalã şi Transplant Hepatic. Material şi metode: Acest studiu retrospectiv include 844 pacienţi diagnosticaţi cu CHC şi trataţi chirurgical cu intenţie de radicalitate. Singurele metode de tratament curativ pentru CHC, la ora actualã sunt reprezentate de rezecţia hepaticã (RH) şi transplantul hepatic (TH). Ablaţia tumoralã poate fi indicatã în tratamentul CHC precoce, în cazurile la care rezecţia sau transplantul hepatic nu se pot efectua. La 518 pacienţi s-a practicat rezecţie hepaticã, 162 au beneficiat de transplant hepatic, iar 164 pacienţi au fost trataţi prin distrucţie cu radiofrecvenţã (RFA). 615 pacienţi (73%) au prezentat cirozã hepaticã. Rezultate: Morbiditatea şi mortalitatea înregistrate pentru întreg lotul de pacienţi au fost de 30% şi respectiv 4,3%. Supravieţuirea la 5 ani a fost de 39% cu diferenţe semnificative statistic între pacienţii la care s-a practicat RH comparativ cu cei transplantaţi şi Chirurgia (2017)

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Section: Resultsmentioning

confidence: 99%

Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center

Grigorie¹,

Alexandrescu²,

Smira³

et al. 2017

chr

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“…However, recent advances in perioperative management and surgical techniques, as well as more restrictive selection of patients for HR, have rapidly reduced perioperative mortality, which was only 1.1 % in the RCT [11]. Moreover, HR can achieve satisfactory overall survival [12] in patients with recurrent HCC. Aggressive treatment of recurrence by repeat HR, radiofrequency ablation (RFA), and adjuvant therapies, such as transarterial chemoembolization (TACE), can offer satisfactory overall survival (OS) [13][14][15].…”

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confidence: 99%

Hepatic resection associated with good survival for selected patients with multinodular hepatocellular carcinoma

Zhong

2014

Tumor Biol.

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As the sixth most common cancer and the third leading cause of cancer-related deaths worldwide, hepatocellular carcinoma (HCC) imposes a significant burden on health care [1]. The geographical distribution of HCC is extremely uneven. Despite the increased frequency of surveillance programs, the majority of patients have an intermediate or advanced stage HCC at diagnosis due to no significant symptoms in early stage. Of these, quite a number of them are with multinodular HCC (≥2). It is therefore vital to choose the most effective and appropriate therapy for these patients.Hepatic resection (HR) is the standard therapy for early stage HCC in non-cirrhotics with a well-preserved liver function [2]. However, the role of HR in the treatment of multinodular HCC remains controversial. According to the widely used Barcelona Clinic liver cancer (BCLC) staging system [3] and its updated review [4], HR should not be recommended to the patients with multinodular HCC [3]. Although the recommendations of BCLC staging system are endorsed by the American Association for the Study of Liver Diseases (AASLD) [5] and the European Association for the Study of the Liver (EASL) [6], many large and qualified liver centers in treating HCC especially those in Asia do not subscribe to these guidelines. Some retrospective studies have demonstrated that HR is superior to palliative treatments for multinodular HCC [7][8][9][10]. Although these retrospective studies may have some unintentional selection bias, the first randomized controlled trial (RCT) by Yin and coworkers definitely support this conclusion [11]. These studies highlight one of the ongoing controversies that surround the BCLC system.The fact that AASLD/EASL guidelines do not recommend HR for patients with intermediate or advanced stage HCC reflects primarily concerns over high recurrence and perioperative mortality, rather than direct prospective clinical evidence. However, recent advances in perioperative management and surgical techniques, as well as more restrictive selection of patients for HR, have rapidly reduced perioperative mortality, which was only 1.1 % in the RCT [11]. Moreover, HR can achieve satisfactory overall survival [12] in patients with recurrent HCC. Aggressive treatment of recurrence by repeat HR, radiofrequency ablation (RFA), and adjuvant therapies, such as transarterial chemoembolization (TACE), can offer satisfactory overall survival (OS) [13][14][15]. Therefore, this trial and other retrospective studies concluding HR superior to TACE makes sense [7][8][9]11].RCTs directly comparing TACE and HR in such patients have been lacking because clinicians are loathe to treat them exclusively with TACE, given the demonstrated survival benefit of HR in many retrospective studies [7][8][9]. For this reason, this RCT [11] stands out as providing clear, direct evidence against current guidelines. Therefore, it is a very valuable study.This RCT was conducted on 173 patients with multinodular HCC outside of Milan criteria who were treated in a big liver center in ...

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“…Other studies found better survival for patients with upward treatment stage migration than patients treated according to the BCLC recommendations (Ruzzenente et al, 2009;Pinter et al, 2012;Radu et al, 2013). Very few patients in this study underwent LDLT.…”

Section: Discussionmentioning

confidence: 94%

Real Life Treatment of Hepatocellular Carcinoma: Impact of Deviation from Guidelines for Recommended Therapy

Alkhatib¹,

Gomaa²,

Allam³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Is Liver Resection Justified in Advanced Hepatocellular Carcinoma? Results of an Observational Study in 464 Patients

Cited by 70 publications

References 22 publications

Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center

Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center

Hepatic resection associated with good survival for selected patients with multinodular hepatocellular carcinoma

Real Life Treatment of Hepatocellular Carcinoma: Impact of Deviation from Guidelines for Recommended Therapy

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