Liver Resection for Transplantable Hepatocellular Carcinoma

Cherqui, Daniel; Laurent, Alexis; Mocellin, N.; Tayar, Claude; Luciani, Alain; Nhieu, Jeanne Tran Van; Decaens, Thomas; Hurtova, Monika; Méméo, Riccardo; Mallat, Ariane; Duvoux, Christophe

doi:10.1097/sla.0b013e3181bd582b

Cited by 253 publications

(83 citation statements)

References 43 publications

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“…Most studies defend anatomic resection as a method to avoid or ameliorate local recurrence [25,26] . Other studies have not been able to confirm this [27] . If the invasive phenotype is minor, as in the case of very early HCC, the spread beyond the segment may be low and anatomic resection may provide a benefit [9] .…”

Section: Liver Resectionmentioning

confidence: 40%

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Management of “very early” hepatocellular carcinoma on cirrhotic patients

Sevilla

Echeverri

Charco

2014

WJH

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Due to the advances in screening of cirrhotic patients, hepatocellular carcinoma (HCC) is being diagnosed in earlier stages. For this reason the number of patients diagnosed of very early HCC (single tumors ≤ 2 cm) is continuously increasing. Once a patient has been diagnosed with this condition, treatment strategies include liver resection, local therapies or liver transplantation. The decision on which therapy should the patient undergo depends on the general patients performance status and liver disease. Anyway, even in patients with similar conditions, the best treatment offer is debatable. In this review we analyze the state of the art on the management of very early HCC on cirrhotic patients to address the best treatment strategy for this patient population.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Hepatocellular carcinoma; Very early; Liver resection; Liver transplantation; Local therapiesCore tip: Very early hepatocellular carcinoma patients are deemed too early for liver transplantation candidacy, known as the best treatment regarding long-term survival and tumor recurrence. Strategies as surgical resection and radiofrequency ablation have gained popularity. Although resection is considered as the first line of treatment, recent studies claim equal results with ablation techniques. Ablation used as a test of time in patients who remain candidates for liver transplantation is attractive. In this review we will analyze in detail the novel strategy repertoire used in the management of these patients.Sapisochin G, Fernandez de Sevilla E, Echeverri J, Charco R. Management of "very early" hepatocellular carcinoma on cirrhotic patients.

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Section: Liver Resectionmentioning

confidence: 40%

“…In these regards, surgeons may have in mind that patients can be transplanted at the time of recurrence [58] . This strategy of secondary LT is called salvage transplantation [27] . Poon et al [59] published that 80% of patients with recurrence after a LR for HCC remain eligible for LT.…”

Section: Re-resectionmentioning

confidence: 99%

Management of “very early” hepatocellular carcinoma on cirrhotic patients

Sevilla

Echeverri

Charco

2014

WJH

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“…Open surgery can provide a proper AR even in more complex disease presentation with a low-risk profile, provided an adequate patient selection [4, 14, 15, 28, 46]. Liver transplantation remains a solution for both the underlying liver cirrhosis and the neoplasm but should be considered upfront only in otherwise untreatable patients (tumor location or compromised liver function) [6-8]. In the patients amenable to resection or ablation, transplantation should be considered a salvage procedure in case of recurrence [6-8].…”

Section: Resultsmentioning

confidence: 99%

Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy

Viganò¹,

Laurenzi²,

Solbiati³

et al. 2018

Dig Surg

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Background: Patients with a single hepatocellular carcinoma (HCC) ≤3 cm and preserved liver function have the highest likelihood to be cured if treated. The most adequate treatment methods are yet a matter that is debated. Methods: We reviewed the literature about open anatomic resection (AR), laparoscopic liver resection (LLR), and percutaneous thermal ablation (PTA). Results: PTA is effective as resection for HCC < 2 cm, when they are neither subcapsular nor perivascular. PTA in HCC of 2–3 cm is under evaluation. AR with the removal of the tumor-bearing portal territory is recommended for HCC > 2 cm, except for subcapsular ones. In comparison with open surgery, LRR has better short-term outcomes and non-inferior long-term outcomes. LLR is standardized for superficial limited resections and for left-sided AR. Conclusions: According to the available evidences, the following therapeutic proposal can be advanced. Laparoscopic limited resection is the standard for any subcapsular HCC. PTA is the first-line treatment for deep-located HCC < 2 cm, except for those in contact with Glissonean pedicles. Laparoscopic AR is the standard for deep-located HCC of 2–3 cm of the left liver, while open AR is the standard for deep-located HCC of 2–3 cm in the right liver. HCC in contact with Glissonean pedicles should be scheduled for resection (open or laparoscopic) independent of their size. Liver transplantation is reserved to otherwise untreatable patients or as a salvage procedure at recurrence.

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“…Authors have even shown that patients who have undergone previous open hepatectomy can enjoy the benefits of a minimally invasive approach [32]. Potential benefits in patients with hepatocellular carcinoma include decreased postoperative ascites, liver failure and lung complications [25,29,33,34]. …”

Section: Discussionmentioning

confidence: 99%

Adopting Gayet’s Techniques of Totally Laparoscopic Liver Surgery in the United States

Gumbs

Gayet

2013

Liver Cancer

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Professor Brice Gayet of the Institut Mutualiste Montsouris in Paris, France, has developed totally laparoscopic techniques for all segments of the liver. As a pioneer in the field of minimally invasive hepato-pancreato-biliary surgery, he started a Minimally Invasive Hepato-Pancreato-Biliary Fellowship in 2006. A retrospective review of all hepatic cases performed by a single surgeon since completing this Fellowship was undertaken. From November 2007 to October 2012, a total of 80 liver resections were done, of which 73 were begun with the intention of completing the case laparoscopically. Of these, more than 90% were completed laparoscopically and 88% were for malignant disease. One of the foundations of Professor Gayet’s techniques is the low lithotomy or ‘French’ position and the utilization of a small robotically controlled laparoscope holder that is sterilizeable and considerably more economic than complete surgical systems. Prototypes exist of robotically controlled hand-held laparoscopic instruments that, unlike the complete surgical system, enable surgeons to maintain a sense of touch (haptics). Proper training in minimally invasive hepato-pancreato-biliary techniques can be obtained with surgeons able to independently perform laparoscopic major hepatectomies without senior minimally invasive backup. Furthermore, miniature and more affordable robotics may enable more surgeons to enjoy the benefits of minimally invasive surgery while maintaining patient safety and minimizing the rising burden of health-care costs worldwide.

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Liver Resection for Transplantable Hepatocellular Carcinoma

Abstract: LR for small solitary HCC in compensated cirrhosis yields an overall survival rate comparable to upfront LT. Despite a significant recurrence rate, close imaging monitoring after resection allows salvage LT in 61% of patients with recurrence on intention to treat analysis.

Cited by 253 publications

References 43 publications

Management of “very early” hepatocellular carcinoma on cirrhotic patients

Management of “very early” hepatocellular carcinoma on cirrhotic patients

Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy

Adopting Gayet’s Techniques of Totally Laparoscopic Liver Surgery in the United States

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