Outcome of patients with huge hepatocellular carcinoma after primary resection and treatment of recurrent lesions

Lee, S. G.; Hwang, Shin; Jung, Jinhong; Lee, Y. J.; Kim, K. H.; Ahn, Chul‐Soo

doi:10.1002/bjs.5622

Cited by 73 publications

(93 citation statements)

References 23 publications

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“…Although various treatments for H-HCC have been applied in clinical practice, hepatic resection remains the most effective because it offers the possibility of long-term survival (Lee et al, 2007;Taniai et al, 2008). However, resection of H-HCC is associated with an increased risk of operative morbidity and mortality largely due to liver failure, compared with small HCC.…”

Section: Discussionmentioning

confidence: 99%

“…With the advancement in surgical techniques, equipment, and post-operative care, liver resection for patients with H-HCC can now be performed with low morbidity and mortality. Majority of current scholars believe that surgery is still preferred for H-HCC because it is the most effective treatment measure (Lee et al, 2007;Taniai et al, 2008). Hemihepatectomy or extended hemihepatectomy is generally performed.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Computer-Assisted Quantitative Volumetric Analysis for Pre-Operative Resectability Assessment of Huge Hepatocellular Carcinoma

Tang

Yan²,

Zhou³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Purpose: Hepatic resection is arguably the preferred treatment for huge hepatocellular carcinoma (H-HCC). Estimating the remnant liver volume is therefore essential. This study aimed to evaluate the feasibility of using computer-assisted volumetric analysis for this purpose. Methods: The study involved 40 patients with H-HCC. Laboratory examinations were conducted, and a contrast CT-scan revealed that 30 cases out of the participating 40 had single-lesion tumors. The remaining 10 had less than three satellite tumors. With the consensus of the team, two physicians conducted computer-assisted 3D segmentation of the liver, tumor, and vessels in each case. Volume was automatically computed from each segmented/labeled anatomical field. To estimate the resection volume, virtual lobectomy was applied to the main tumor. A margin greater than 1 cm was applied to the satellite tumors. Resectability was predicted by computing a ratio of functional liver resection (R) as (VresectedVtumor)/(Vtotal-Vtumor) x 100%, applying a threshold of 50% and 60% for cirrhotic and non-cirrhotic cases, respectively. This estimation was then compared with surgical findings. Results: Out of the 22 patients who had undergone hepatectomies, only one had an R that exceeded the threshold. Among the remaining 18 patients with non-resectable H-HCC, 12 had Rs that exceeded the specified ratio and the remaining 6 had Rs that were < 50%. Four of the patients who had Rs less than 50% underwent incomplete surgery due to operative findings of more extensive satellite tumors, vascular invasion, or metastasis. The other two cases did not undergo surgery because of the high risk involved in removing the tumor. Overall, the ratio of functional liver resection for estimating resectability correlated well with the other surgical findings. Conclusion: Efficient pre-operative resectability assessment of H-HCC using computer-assisted volumetric analysis is feasible.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of Computer-Assisted Quantitative Volumetric Analysis for Pre-Operative Resectability Assessment of Huge Hepatocellular Carcinoma

Tang

Yan²,

Zhou³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…However, tumor size is not an absolute contraindication for LR [50] . Longterm survival varies from 66% in cases of less than 5 cm lesions to 37% in the group of large (> 5 cm) HCC [46][47][48][49][50] . Vascular invasion is an independent factor affect prognosis and is strongly associated with both size and histological grade.…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…Other factors affect prognosis includes AFP levels, age and concomitant diseases [46,49] . In addition, genetic signature of the tumor is attributed to both disease free and overall survival [46,49,50] . The role of hepatic resection for bilobar HCCs is controversial.…”

Section: Prognostic Factorsmentioning

confidence: 99%

Selection criteria for liver resection in patients with hepatocellular carcinoma and chronic liver disease

Delis¹,

Dervenis²

2008

WJG

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H e p a t o c e l l u l a r c a rc i n o m a ( H C C ) i s o n e o f t h e most common malignancies worldwide with an annual occurrence of one million new cases. An etiologic association between HBV infection and the development of HCC has been established with a relative risk 200-fold greater than in non-infected individuals. Hepatitis C virus is also proving an important predisposing factor for this malignancy with an incidence rate of 7% at 5 years and 14% at 10 years. The prognosis depends on tumor stage and degree of liver function, which affect the tolerance to invasive treatments. Although surgical resection is generally accepted as the treatment of choice for HCC, new treatment strategies, such as local ablative therapies, transarterial embolization and liver transplantation, have been developed nowadays. With increasing detection of small HCCs from screening programs for cirrhotic patients, it is foreseen that locoregional therapy will play an important role in the near future.

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“…Surgical technique and postoperative treatment have been reported previously [20] . Anatomical resections including sectionectomy and lobectomy were performed in 44 patients, and nonanatomical resections, defined by partial hepatectomy or segmentectomy according to Couinaud's classification, were done in 56 patients ( table 2 ).…”

Section: Hepatic Resectionmentioning

confidence: 99%

Liver Transplantation for Hepatocellular Carcinoma: Single Nodule with Child-Pugh Class A Sized Less than 3 cm

Moon

Lee²,

Hwang³

2007

Dig Dis

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Backgrounds/Aims: Hepatic resection (HR) has been the standard therapy for patients with small hepatocellular carcinoma (HCC) with preserved liver function in Child A cirrhosis. However, the underlying cirrhosis is responsible for high recurrence and long-term complications of portal hypertension and liver failure. Currently, liver transplantation (LT) has proven to be a good alternative to HR. We studied to determine whether LT could be an alternative initial therapy or not in HCC patients with less than 3 cm-sized, single nodule with Child A cirrhosis. Methods: From January 1995 to December 2005, there were 100 HR and 17 LT (living donor LT 15, deceased donor LT 2) patients. Clinicopathologic characteristics were reviewed and survival rates between LT and HR groups were compared. The applicability of salvage LT at the time of recurrence was also evaluated. Results: There was no difference in age, sex, etiology and in-hospital mortality between the two groups. LTs were not performed for the patients with preserved liver function, that is, BCLC stage A1. Most initial recurrences after HR occurred in liver (37/39), but only one recurrence after LT occurred in lung. Overall survival differences between LT and HR were not significant. However, disease-free survival after LT and HR were significantly different (p = 0.047). Potential candidates for salvage LT were 37 patients including hepatic failure (n = 10), and its applicability on recurrence was 69.2% (27/39). Conclusion: HR is still a good option for the selected patients because of lower cost and no requirement of donors. However, primary LT can be a treatment of choice for single, small HCC of Child A cirrhosis in the presence of portal hypertension because of excellent disease-free survival.

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Outcome of patients with huge hepatocellular carcinoma after primary resection and treatment of recurrent lesions

Abstract: In patients with huge HCC, hepatic resection combined with active treatment for recurrence resulted in longer-term survival. Frequent protocol-based follow-up appears to be beneficial for the early detection and timely treatment of recurrence.

Cited by 73 publications

References 23 publications

Evaluation of Computer-Assisted Quantitative Volumetric Analysis for Pre-Operative Resectability Assessment of Huge Hepatocellular Carcinoma

Evaluation of Computer-Assisted Quantitative Volumetric Analysis for Pre-Operative Resectability Assessment of Huge Hepatocellular Carcinoma

Selection criteria for liver resection in patients with hepatocellular carcinoma and chronic liver disease

Liver Transplantation for Hepatocellular Carcinoma: Single Nodule with Child-Pugh Class A Sized Less than 3 cm

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