Is there a standard for surgical therapy of hepatocellular carcinoma in healthy and cirrhotic liver? A comparison of eight guidelines

Manzini, Giulia; Henne‐Bruns, Doris; Porzsolt, Franz; Kremer, Michael

doi:10.1136/bmjgast-2016-000129

Cited by 19 publications

(14 citation statements)

References 56 publications

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“…85 In patients without significant fibrosis, resection is universally advised as first-line treatment, but in patients with compensated cirrhosis, recommendations are mixed and vary by tumor size and number. 86 In patients otherwise eligible for LT, postresection 5-year recurrence-free survival is 40%-50%. 87,88 While 10-year overall survival is better with LT for resectable HCC, 89 many studies have shown similar 5-year overall survival for resection compared to LT in patients with a single <3 cm HCC.…”

Section: Management Of Single Small Hcc Liver Transplantation Versusmentioning

confidence: 99%

Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference

et al. 2020

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Liver transplantation (LT) offers excellent long-term outcome for certain patients with hepatocellular carcinoma (HCC), with a push to not simply rely on tumor size and number. Selection criteria should also consider tumor biology (including alpha-fetoprotein), probability of waitlist and post-LT survival (ie, transplant benefit), organ availability, and waitlist composition. These criteria may be expanded for live donor LT (LDLT) compared to deceased donor LT though this should not adversely affect the double equipoise in LDLT, namely ensuring both acceptable recipient outcomes and donor safety. HCC patients with compensated liver disease and minimal tumor burden have low urgency for LT, especially after local-regional therapy with complete response, and do not appear to derive the same benefit from LT as other waitlist candidates. These guidelines were developed to assist in selecting appropriate HCC patients for both deceased donor LT and LDLT.

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Section: Management Of Single Small Hcc Liver Transplantation Versusmentioning

confidence: 99%

Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference

et al. 2020

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“…Treatment of early stage HCC is liver resection or transplantation, whereas for patients with BCLS stage B HCC, the recommended treatment is TACE or palliative treatment. However, recent reports suggest surgical treatment can achieve prolonged survival in advanced HCC patients [ 71 , 42 , 72 – 74 ], even patients with IVC invasion, as occurred in a patient in this series (60 months survival). These findings may justify an aggressive surgical approach and support the use of ALPPS in patients with BCLC stage B HCC.…”

Section: Discussionmentioning

confidence: 59%

Tourniquet-ALPPS is a promising treatment for very large hepatocellular carcinoma and intrahepatic cholangiocarcinoma

et al. 2018

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When very large hepatocellular carcinomas (HCCs) and intrahepatic cholangiocarcinoma (IHCCs) with insufficient future liver remnants are treated using associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), the outcome is often poor. We therefore tested the efficacy of a modified version of that technique, tourniquet-ALPPS. A review of the literature examining outcomes of HCC and IHCC patients treated with ALPPS revealed the incidences of morbidity ≥ III and postoperative mortality to be respectively 20.7% and 16.1% among HCC patients and 50% and 45.4% among IHCC patients. In the present case series, in which HCC and IHCC patients were treated with tourniquet-ALPPS, median tumor size was 100 mm (range: 70–200 mm). After surgical stage I, there was no morbidity, no mortality and the median future liver remnant had increased at day 7 by 76%. In surgical stage II, 100% of tumors were resectable (8 right trisectionectomies, 5 with inferior vena cava resection). Two patients experienced serious morbidity ≥ IIIB and 1 patient died (11%). One- and 3-year overall survival was 75% and 60%, respectively. Thus tourniquet-ALPPS appears to be an effective alternative to classical ALPPS for the treatment of patients with HCC or IHCC.

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“…Hepatic resection seems to be the best therapeutic choice for patients with HCC in normal liver and the preserved liver function allows very large hepatic resections. Three of our cases experienced early recurrence within 15 months after surgery. In two cases, a small recurrent nodule was detected and treated successfully with RFA.…”

Section: Discussionmentioning

confidence: 71%

Hepatocellular carcinoma in otherwise sonographically normal liver

Naganuma¹,

Ishida

Ogawa

et al. 2018

J of Clinical Ultrasound

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Purpose Hepatocellular carcinoma (HCC) on normal liver is very rare. The goal of this study was to determine the clinical manifestations and the role of ultrasonography (US) in the diagnosis of HCC arising in normal liver. Methods The clinical data and US findings in 12 cases of surgically resected HCC in normal liver were retrospectively analyzed. Results The patients were asymptomatic, had no hepatocarcinogenic factor, and hepatic function tests were almost normal in most cases. HCCs were large, encapsulated, and solitary, and there were predominantly well‐differentiated or moderately differentiated in most cases. US showed a hypoechoic rim and lateral shadowing, suggestive of peritumoral capsule formation, and on contrast‐enhanced US (CEUS), the tumor was hyperenhanced in arterial phase and washed out in postvascular phase, revealing typical HCC findings. Conclusions US raises suspicion of HCC by showing lateral shadowing on grayscale ultrasound and hypervascularity on CEUS of the lesion.

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Is there a standard for surgical therapy of hepatocellular carcinoma in healthy and cirrhotic liver? A comparison of eight guidelines

Cited by 19 publications

References 56 publications

Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference

Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference

Tourniquet-ALPPS is a promising treatment for very large hepatocellular carcinoma and intrahepatic cholangiocarcinoma

Hepatocellular carcinoma in otherwise sonographically normal liver

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