Liver resection for multifocal hepatocellular carcinoma: is it an option?

Viganò, Luca; Costa, Guido; Tommaso, Luca Di

doi:10.21037/hbsn.2019.05.12

Cited by 4 publications

(7 citation statements)

References 19 publications

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“…In clinical practice, the decision to pursue LR and TA is complex and influenced by several factors, including surgeon experience, geographic location, institution experience, patient comorbidities, tumor location, tumor size, and expected future liver remnant (FLR). 9,25,26 Historically, proponents of ablation have often cited the minimal invasiveness of ablation and obviation of extensive LR that increases morbidity and mortality risk for a disease with an already dire prognosis. Conversely, proponents of resection now often emphasize longer recurrence-free survival and the potential of laparoscopic hepatic resections to mitigate some risks associated with open surgery.…”

Section: Discussionmentioning

confidence: 99%

Liver resection is superior to tumor ablation in patients with multifocal hepatocellular carcinoma

Kakish,

Suraju,

Davis

et al. 2024

Journal of Surgical Oncology

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IntroductionThe management of T2 multifocal hepatocellular carcinoma (MHCC) is controversial, and the comparative impact of liver resection (LR) versus tumor ablation (TA) on survival continues to be debated. The aim of our study was to examine short‐ and long‐term survival for LR and TA in a nationally representative cohort. We hypothesized that patients who underwent LR would have improved survival.MethodsWe utilized the National Cancer Database (2004–2015) to identify patients diagnosed with non‐metastatic T2 MHCC. Kaplan–Meier survival curves were generated to compare 10‐year overall survival (OS) between LR and TA patients. Kaplan–Meier analysis with stratification was also performed based on lymphovascular invasion, resection margin status, and Charlson–Deyo score. Cox proportional hazard models were used in multivariable analyses.ResultsA total of 1225 patients met the inclusion criteria. 991 patients received LR, and 234 received TA. The majority of patients were male, White, and older than ≥60 years old. Clinicodemographic characteristics were generally similar between LR and TA patients. Among patients who underwent LR, 84% had negative margins, and 17% had lymphovascular invasion. Mortality at 30 days was significantly higher among LR patients compared to TA patients (5.4% vs 0.0%, p < 0.001), with those having a Charlson–Deyo score ≥2 facing the highest risk at 7.3%. Nevertheless, 10‐year OS for the LR cohort was 27.5% (95% confidence interval [CI]: 24.4%–30.8%) versus 14.7% (95% CI: 9.8%–20.7%, p < 0.001) for TA patients. In stratified analysis, survival benefit was statistically significant only among those with negative resection margin, no lymphovascular invasion, and Charlson–Deyo score ≤1. In multivariable Cox analysis, LR was independently associated with improved survival compared to TA (hazard ratio: 0.80; 95% CI = 0.67–0.95).ConclusionLR poses a higher long‐term survival benefit than TA. Prospective studies are warranted to confirm these findings. Although our study patients are a highly selected group of multifocal T2 patients, it gives us a good insight into the fact that LR provides better outcomes if a transplant option is unavailable.

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Section: Discussionmentioning

confidence: 99%

Liver resection is superior to tumor ablation in patients with multifocal hepatocellular carcinoma

Kakish,

Suraju,

Davis

et al. 2024

Journal of Surgical Oncology

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“…shorter than that of patients with metachronous multiple HCC. Therefore, patients with metachronous multiple HCC (≤ 3 nodules) are good candidates for resection (20).…”

Section: Figure 2 Survival Of Patients With Multiple Hcc (A)mentioning

confidence: 99%

“…On multivariate analysis, the survival of patients with synchronous multiple HCC was shorter in the older patients with larger tumors, tumor thrombus, and liver cirrhosis. Given that surgical outcomes of patients with multiple HCC are not preferable (9,10), the candidates for liver resection should be determined based on the patient background, tumor status, and liver function (20); however, studies have showed the superiority of liver resection to TACE for multiple HCC (6,7).…”

Section: Figure 2 Survival Of Patients With Multiple Hcc (A)mentioning

confidence: 99%

Comparison of the surgical outcomes in patients with synchronous versus metachronous multiple hepatocellular carcinoma

Midorikawa

Takayama

Higaki

et al. 2020

BST

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“…Hepatocellular carcinoma (HCC) accounts for 85-90% of cases of primary liver cancer (1), which is still the third most common cause of cancer-associated death worldwide (2). An estimated 35-40% of HCC patients already have multifocal disease when they are first diagnosed (3)(4)(5), with a 5-year overall survival (OS) rate of just 19.5% (3).…”

Section: Introductionmentioning

confidence: 99%

Transarterial chemoembolization with 125I seed insertion for multifocal hepatocellular carcinoma

Wang,

Zhang,

et al. 2024

Front. Oncol.

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BackgroundA common treatment strategy for individuals with multifocal hepatocellular carcinoma (HCC) who are not candidates for surgical resection is transarterial chemoembolization (TACE). Combining TACE with 125I seed insertion (ISI) may offer a means of enhancing therapeutic efficacy. The purpose of this study was to compare the therapeutic efficacy of TACE administered with and without ISI for the treatment of multifocal HCC.MethodsThe data from the two centers were analyzed retrospectively. The present study involved 85 consecutive patients with multifocal HCC who underwent TACE between January 2018 and December 2021. Of these patients, 43 were in the combined group, receiving TACE with ISI, and 42 were in the TACE-only group, receiving TACE without ISI. Comparisons of treatment outcomes were made between these groups.ResultsNo significant differences in baseline data were observed between these groups of patients. Higher rates of complete (60.5% vs. 33.3%, P = 0.016) and total (93.0% vs. 61.9%, P = 0.001) responses were evident in the combined group compared to the TACE-only group. Median progression-free survival (PFS, 13 vs. 10 months, P = 0.014) and overall survival (OS, 22 vs. 17 months, P = 0.035) were also significantly longer in the combined group than in the TACE-only group. Using a Cox regression analysis, risk variables associated with shorter PFS and OS included Child-Pugh B status (P = 0.027 and 0.004) and only TACE treatment (P = 0.011 and 0.022).ConclusionIn summary, these findings suggest that, as compared to TACE alone, combining TACE and ISI can enhance HCC patients’ treatment outcomes and survival.

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Liver resection for multifocal hepatocellular carcinoma: is it an option?

Cited by 4 publications

References 19 publications

Liver resection is superior to tumor ablation in patients with multifocal hepatocellular carcinoma

Liver resection is superior to tumor ablation in patients with multifocal hepatocellular carcinoma

Comparison of the surgical outcomes in patients with synchronous versus metachronous multiple hepatocellular carcinoma

Transarterial chemoembolization with 125I seed insertion for multifocal hepatocellular carcinoma

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