Selective devascularization treatment for large hepatocellular carcinoma: Stage 2A IDEAL prospective case series

Elsanousi, Osama M.; Mohamed, Murtada A.; Salim, Fatima H.; Adam, Elsadig Ahmed

doi:10.1016/j.ijsu.2019.06.014

Cited by 8 publications

(6 citation statements)

References 22 publications

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“…Many procedures and clinical studies in which HA was attached due to liver pathologies have been described. [ 21 , 22 ] It has been reported that with the ligating of HA, the amount of blood coming to the liver will decrease by 35%, whereas the blood requirement of a metastatic tumor in the liver will decrease by 95%. [ 21 ] In their 19 disease HCC series of Elsanousi et al,[ 22 ] 13 of the patients who underwent HA ligation and extrahepatic collateral division (HALED) received a complete response, and they did not see any abscess and necrosis in the liver.…”

Section: Discussionmentioning

confidence: 99%

Management of hepatic artery trauma during hepato-pancreato-biliary procedures: Evolving approaches, clinical outcomes, and literature review

Atay

Güngör

Sür

et al. 2022

Ulus Travma Acil Cerrahi Derg

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Management of hepatic artery trauma during hepatopancreato-biliary procedures: Evolving approaches, clinical outcomes, and literature review studies conducted, there is a common belief that more HA injuries occur in patients with anomalies. [3][4][5] In autopsy studies, it has been stated that deaths seen as a result of HA injury are mostly due to liver necrosis. Necrosis that occurs in the liver is diffuse or patchy. [1,3] Although significant improvements in complications and mortality rates due to HA injuries have been detected in recent years, it still continues to cause serious morbidity and mortality. [3,6] Better results are obtained today with a better understanding of liver physiology, antibiotics, early diagnosis, interventional procedures, and improved intensive care conditions.

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Section: Discussionmentioning

confidence: 99%

Management of hepatic artery trauma during hepato-pancreato-biliary procedures: Evolving approaches, clinical outcomes, and literature review

Atay

Güngör

Sür

et al. 2022

Ulus Travma Acil Cerrahi Derg

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“…This effect is observed more in hypervascular metastases (hypernephroma, leiomyosarcoma, carcinoid, papillary adenocarcinoma of the pancreas)[ 32 ]. In their 19-disease invasive hepatocellular carcinoma series by Elsanousi et al [ 34 ], 13 of the patients who underwent ligation of HA on the lesion side and extrahepatic collateral divisions (HALED) received a complete response. They also reported that there were no abscesses and necrosis in the liver.…”

Section: Discussionmentioning

confidence: 99%

Dealing with hepatic artery traumas: A clinical literature review

Dılek¹,

Atay²

2021

WJCC

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BACKGROUND The hepatic artery (HA) is one of the most threatened vascular structures during hepatopancreatobiliary (HPB) surgeries and interventional procedures. It can be affected by many clinical pictures, especially tumors, due to its anatomical position and neighborhood. AIM To reveal the evolution and recent developments in the management of HA traumas in the light of the literature. METHODS In this article, 100 years of MEDLINE (PubMed) literature and articles including cases and series of HA injuries were reviewed, and the types of injury occurrence, treatment, and related complications and their management were compiled. RESULTS The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies, among the most common operations. HA anatomy shows anomalies in approximately 15%-25% of the cases, further increasing this risk. The incidence of HA injury is not precisely known. Approaches that have evolved in recent years in managing patients with HA injury (laceration, transection, ligation, resection) with severe morbidity and mortality risk are reviewed in light of the current literature. CONCLUSION In conclusion, complications and deaths due to HA injury are less common today. The risk of complications increases in patients with hemodynamic instability, jaundice, cholangitis, and sepsis. Revealing the variations in the preoperative radiological evaluation will reduce the risks. In cases where HA injury is detected, arterial flow continuity should be tried to maintain with primary anastomosis, arterial transpositions, or grafts. In cases where bile duct injury develops, patients should be directed to HPB surgery centers, considering the possibility of accompanying HA injury. Large-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.

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“…When compared to monotherapy the efficacy of alcohol combination with TACE is controversially reported as a treatment for the large and unresectable HCC [ 6 , 25 ]. The pooled results showed that the combination therapy of TACE plus PEI significantly improved 1, 2, 3-year survival rate when compared with that of TACE or PEI alone.…”

Section: Discussionmentioning

confidence: 99%

“…HCC treatment combination concept is another option. Accordingly, percutaneous ethanol alcohol injection (PEI) role in potentiating the therapeutic effect of TACE has also been tried with encouraging outcomes [ 6 ]. Limitations of all these alternatives (including extrahepatic tumor vascular feeders unattainable by the TACE) made them unsatisfactory [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcome of novel combined surgical-injection treatment (COSIT) for large hepatocellular carcinoma: Stage 2A IDEAL prospective case series

Elsanousi

Mohamed

Salim

et al. 2021

Annals of Medicine and Surgery

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Background Large hepatocellular carcinoma (HCC) treatment options have obvious limitations. Our trial comprises ipsilateral hepatic artery ligation and extrahepatic collaterals division (HALED, reinforced by percutaneous tumor injection controlling residual HCC arterial supply. We aimed to evaluate the long term safety and feasibility of the Combined Surgical and Injection of alcohol Treatment (COSIT) as a novel therapy for the large HCC. Material and methods Candidates' clinical data of the of this case series were prospectively and sequentially reported in accordance with stage 2a development IDEAL (Idea, Development, Exploration, Assessment and Long-term monitoring) recommendations. It included adult patients with HCC (diameter >5 cm) subjected to COSIT coming to our center during a five years' trial evaluating the long term outcome measures. Study ID (NCT03138044 ClinicalTrials.gov ). Results Patients were 21, their mean age (±standard deviation) was 61·9 (±9·3) years. Eleven (52.4%) patients had tumors diameter >10 cm. 17 (80.9%) patients were advanced BCLC stage. Six modifications were made in this injection phase till it came to a stability. The mean alcohol volume was 72.0 mls. The mean follow-up duration was 16 months. The median overall survival duration was 14 months. The one, three and five years' survival was 71.4%, 23.8% and 4.8%, respectively. Grade 3/4 and 4 Common Toxicity Criteria for Adverse Effects (v4.03) were encountered in 10 (47.6%) and one (4.8%) patients, respectively. Conclusion This preliminary findings of COSIT can be a promising alternative treatment for patients having large HCC. Consequently, a multicenter stage 2b Exploration IDEAL trial is suggested.

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Selective devascularization treatment for large hepatocellular carcinoma: Stage 2A IDEAL prospective case series

Cited by 8 publications

References 22 publications

Management of hepatic artery trauma during hepato-pancreato-biliary procedures: Evolving approaches, clinical outcomes, and literature review

Management of hepatic artery trauma during hepato-pancreato-biliary procedures: Evolving approaches, clinical outcomes, and literature review

Dealing with hepatic artery traumas: A clinical literature review

Long-term outcome of novel combined surgical-injection treatment (COSIT) for large hepatocellular carcinoma: Stage 2A IDEAL prospective case series

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