Outcomes of anterior approach major hepatectomy with diaphragmatic resection for single huge right lobe HCC with diaphragmatic invasion

Zheng, Jinli; Shen, Shu; Jiang, Li; Yan, Lü-Nan; Yang, Jiayin; Li, Bo; Wen, Tianfu; Wang, Wentao; Xu, Meiqing

doi:10.1097/md.0000000000012194

Cited by 13 publications

(13 citation statements)

References 36 publications

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“…In the current study, the 90-day mortality in patients with huge HCC accompanied by PVTT was significantly higher than in patients without PVTT (22.8% vs. 4.1%, P<0.001). The mortality rates both in the patients with PVTT and without PVTT were consistent with findings from the previous literature (8,9,45,46). The proportion of patients with PVTT might play a major role in the total mortality rate.…”

Section: Discussionsupporting

confidence: 90%

“…Surgical resection is considered a potential curative option for these patients and has been reported to provide a favorable overall survival (OS) in some patients (3,4). Although mortality after liver resection has been dramatically reduced in recent years with advances in surgical techniques and perioperative management (5)(6)(7), the postoperative mortality rate of hepatectomy for huge HCC, ranging from 2.7% to 18.1%, is still much higher than the routine liver resection (~1%) (8)(9)(10). As the natural history for a patient with advanced HCC is approximately 3-6 months after diagnosis (11), death within 3 months after hepatectomy is regarded as "futile liver resection," which should be avoided because it provides no survival benefit (8,12).…”

Section: Introductionmentioning

confidence: 99%

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A novel preoperative predictive model of 90-day mortality after liver resection for huge hepatocellular carcinoma

Yin¹,

Chen²,

Chen³

et al. 2021

Ann Transl Med

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Background: Hepatectomy for huge hepatocellular carcinoma (HCC) (diameter ≥10 cm) is characterized by high mortality. This study aimed to establish a preoperative model to evaluate the risk of postoperative 90-day mortality for huge HCC patients. Methods: We retrospectively enrolled 1,127 consecutive patients and prospectively enrolled 93 patients with huge HCC who underwent hepatectomy (training cohort, n=798; validation cohort, n=329; prospective cohort, n=93) in our institute. Based on independent preoperative predictors of 90-day mortality, we established a logistic regression model and visualized the model by nomogram.Results: The 90-day mortality rates were 9.6%, 9.2%, and 10.9% in the training, validation, and prospective cohort. The α-fetoprotein (AFP) level, the prealbumin levels, and the presence of portal vein tumor thrombosis (PVTT) were preoperative independent predictors of 90-day mortality. A logistic regression model, AFP-prealbumin-PVTT score (APP score), was subsequently established and showed good performance in predicting 90-day mortality (training cohort, AUC =0.87; validation cohort, AUC =0.91; prospective cohort, AUC =0.93). Using a cut-off of −1.96, the model could stratify patients into low risk (≤−1.96) and high risk (>−1.96) with different 90-day mortality rates (~30% vs. ~2%). Furthermore, the predictive performance for 90-day mortality and overall survival was significantly superior to the Child-Pugh score, the model of end-stage liver disease (MELD) score, and the albumin-bilirubin (ALBI) score. Conclusions:The APP score can precisely predict postoperative 90-day mortality as well as long-term survival for patients with huge HCC, assisting physician selection of suitable candidates for liver resection and improving the safety and efficacy of surgical treatment.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

A novel preoperative predictive model of 90-day mortality after liver resection for huge hepatocellular carcinoma

Yin¹,

Chen²,

Chen³

et al. 2021

Ann Transl Med

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“…The high levels of AFP has been proved having more aggressive behaviors in previous ndings [27,28], especially for the levels of AFP higher than 1000 ng/mL. On the other hand, the levels of AFP higher than 400 ng/mL is a risk factor in huge tumors [29,30]. In the current study, the levels of AFP (≥400 ng/mL) has no signi cant difference.…”

Section: Discussionmentioning

confidence: 40%

The Long-term Outcomes of Hepatic Resection Between Single Tumor and Multiple Tumors of HCC Meeting UCSF Criteria

Zheng¹,

Xie²,

Huang³

et al. 2021

Preprint

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Object: Searching the hepatectomy of hepatocellular carcinoma (HCC) within UCSF is limited. The study aims to compare the long-term surgical outcomes between single and multiple tumors to find an effective and safe treatment for the patients within UCSF criteria.Methods: We have enrolled 1006 patients meeting UCSF criteria, including 744 patients with single tumor and 262 patients with multiple tumors undergoing hepatic resection (HR). We divided the patients into two groups: single tumor group and multiple tumor group. By comparing the long-term outcomes between these two groups and analyzing the risk factors by the log-rank test and cox proportional hazards model in two groups.Results: The 1-, 3-, and 5-year OS rates in the single tumor group were significantly higher than the multiple tumors group (96.2%, 65.3% and 40.1% versus 93.1%, 47.6% and 22.5%, respectively, p<0.001). The 1-, 3- and 5-year RFS rates were 91.4%, 46.2%, and 24.6% in the single group and 90.8%, 31.1% and 13.0%, respectively (p<0.001). And the anatomic resection and MVI were the independent risk factors for single tumor, but it didn’t work for multiple tumors. The independent risk factors of multiple tumors are the diameter more than 2cm of the maximum tumor and the tumors located in different segments.Conclusion: The surgical resection will obtain a better outcomes for the HCC with single tumor meeting UCSF criteria than the multiple tumors. And the anatomic resection should be applied for the patients with single tumor, if possible.

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“…HCC with diaphragmatic invasion often requires tumor en bloc with part of the diaphragm is often resected and anterior approach is recommended in minimizing intraoperative bleeding. [ 29 ] In advanced HCC patients, LT offers the best long-term survival when compared to complete resection, often limited by the amount of the future liver remnant, is believed to offer better 1- and 3-year survival. When the liver functional reserve becomes doubtful, other treatments such as transcatheter arterial chemoembolization (TACE), radiofrequency ablation (RFA) and liver transplantation are still available as treatment options.…”

Section: Discussionmentioning

confidence: 99%

A nomogram for prediction of early allograft dysfunction in living donor liver transplantation

Tsai

Lee

et al. 2020

Medicine

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Liver transplantation is the treatment of choice for end-stage liver diseases. However, early allograft dysfunction (EAD) is frequently encountered and associated with graft loss or mortality after transplantation. This study aimed to establish a predictive model of EAD after living donor liver transplantation. A total of 77 liver transplants were recruited to the study. Multivariate analysis was utilized to identify significant risk factors for EAD. A nomogram was constructed according to the contributions of the risk factors. The predictive values were determined by discrimination and calibration methods. A cohort of 30 patients was recruited to validate this predictive model. Four independent risk factors, including donor age, intraoperative blood loss, preoperative alanine aminotransferase (ALT), and reperfusion total bilirubin, were identified and used to build the nomogram. The c-statistics of the primary cohort and the validation group were 0.846 and 0.767, respectively. The calibration curves for the probability of EAD presented an acceptable agreement between the prediction by the nomogram and the actual incidence. In conclusion, the study developed a new nomogram for predicting the risk of EAD following living donor liver transplantation. This model may help clinicians to determine individual risk of EAD following living donor liver transplantation.

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Outcomes of anterior approach major hepatectomy with diaphragmatic resection for single huge right lobe HCC with diaphragmatic invasion

Cited by 13 publications

References 36 publications

A novel preoperative predictive model of 90-day mortality after liver resection for huge hepatocellular carcinoma

A novel preoperative predictive model of 90-day mortality after liver resection for huge hepatocellular carcinoma

The Long-term Outcomes of Hepatic Resection Between Single Tumor and Multiple Tumors of HCC Meeting UCSF Criteria

A nomogram for prediction of early allograft dysfunction in living donor liver transplantation

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