Multidisciplinary decision making in the management of hepatocellular carcinoma: A hospital-based study

Abstract

Background/Aims: To evaluate the short-term outcome of the decision taken by the Hepatoma Board for the treatment of Hepatocellular carcinoma (HCC). Materials and Methods: This was a prospective descriptive study involving 74 patients with HCC diagnosed by the known criteria. The decisions taken by the Hepatoma Board for the 74 patients were as follows: 1-surgical resection (7 patients), 2-local ablative therapy (LAT) (22 patients), 3-conventional transarterial chemoembolization (TACE) (24 patients), and 4-palliative supportive care (21 patients).Results: The short-term mortality rate was 25.7% of the total patients. The success rate was nearly equal in LAT (68.2%) and surgery (71.4%), whereas the success rate was approximately 33.3% in TACE. There was no difference in the mean total bilirubin level before and after LAT, surgery, or TACE (p>0.05 for each). There was a significant decrease in the mean serum albumin level after TACE (p=0.000). There was a decrease in the mean alpha fetoprotein level after surgery and LAT (p=0.033) for surgery and (p=0.048) for LAT. Conclusion: The management of HCC is better performed through a multidisciplinary team decision. Surgery has comparable outcome to LAT but is more invasive. According to our local experience, conventional TACE has a success rate of 33.3%.

Egyptian Society of Liver Cancer Recommendation Guidelines for the Management of Hepatocellular Carcinoma

“…94 A hospital-based prospective study conducted in Egypt demonstrated improved management of HCC through an MDT decision. 95 According to the literature, an MDT should include hepatologists, medical and surgical oncologists, transplant surgeons, diagnostic and interventional radiologists, pathologists, radiation oncologists, nurses, supportive care specialists, and palliative physicians. 96 All members play an essential and active role as their expertise is required to provide optimum care for HCC patients.…”

Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients

“…However, MDT with participation by experts from multiple academic disciplines requires additional medical resources and time per patient, which leads to significant healthcare burden and high cost [17]. Several previous studies suggested that MDT management for HCC may improve survival [18–24], yet is limited by analyzing small number of patients [18–22], comparing patients who were treated in different time period [18,19,22], including those only received MDT management [20,21,23,24], or including those who received curative treatment only [20]. Recently, Serper et al, reported that MDT management was associated with reduced mortality, by analyzing 3,988 patients who received care through the Veterans Administration in involving 128 centers in U.S. [25].…”

A Fuzzy Scheduling Approach for Medicine Supply in Hospital Management Information System with Uncertain Demand

“…Barboni (2015) reviewed computer-aided diagnosis system based on fuzzy logic for breast cancer categorization [22]. Zaky (2015) studied multidisciplinary decision making in the management of hepatocellular carcinoma with a hospital-based study [23]. Germini (2015) illustrated Padua prediction score or clinical judgment for decision making on antithrombotic prophylaxis in a quasi-randomized controlled trial [24].…”