Surgical resection combined with chemotherapy for advanced hepatocellular carcinoma with tumor thrombus: Report of 19 cases

Fukuda, Shuichi; Okuda, K; Imamura, Mahiro; Imamura, Ichiro; Eriguchi, Naofumi; Aoyagi, Shigeaki

doi:10.1067/msy.2002.120668

Cited by 83 publications

(71 citation statements)

References 19 publications

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“…The application of advanced surgical techniques and instrumentation decreases blood loss, increases outcomes such as survival and quality of life, and decreases the need for the Pringle maneuver compared with that for portal triad clamping [32][33][34][35]. As mentioned above, the best candidates for surgical resection are patients with very early-or early-stage HCC, although resection in patients with more advanced stages of HCC has been reported with acceptable outcomes [24,36,37]. Tumor size, tumor nodules, liver function, and portal pressure have been identified as prognostic predictors after liver resection [29,38,39].…”

Section: Liver Resectionmentioning

confidence: 99%

Treatment of Hepatocellular Carcinoma: A Systematic Review

Hoffmann²,

2012

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Hepatocellular carcinoma (HCC) is one of the most common malignancies, with an increasing incidence. With advances in surgical techniques and instrumentation and the development of molecular-target drugs, a number of potentially curative treatments have become available. Management of HCC patients depends on the stage of their tumor. Liver resection remains the first choice for very early-stage HCC, but it is being challenged by local ablative therapy. For early-stage HCC that meet the Milan criteria, liver transplantation still offers a better outcome; however, local ablative therapy can be a substitute when transplantation is not feasible. Local ablation is also used as a bridging therapy toward liver transplantation. HCC recurrence is the main obstacle to successful treatment, and there is currently no effective means of preventing or treating HCC recurrence. Transarterial therapy is considered suitable for intermediate-stage HCC, while sorafenib is recommended for advanced-stage HCC. This stage-based approach to therapy not only provides acceptable outcomes but also improves the quality of life of HCC patients. Because of the complexity of HCC, therapeutic approaches ﾭcusses the current standards and trends in the treatment of HCC.

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Section: Liver Resectionmentioning

confidence: 99%

Treatment of Hepatocellular Carcinoma: A Systematic Review

Hoffmann²,

2012

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“…The overall recurrence was 30.1%, 62.3% and 79.0% in 1, 3, 5 years after resection of HCC, respectively [5] . Adjuvant therapies were used to prolong the survival and decrease the recurrence of HCC in different centers, such as transcatheter arterial chemoembolization (TACE) [6][7][8][9][10][11][12][13] , polyprenoic acid [14] , adoptive immunotherapy [15] , interferon [16] , and iodine-131-labeled lipiodol [17][18][19] . TACE was one of the most commonly used adjuvant managements for preventing recurrence and prolonging the survival of patients postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor: A retrospective control study

Ren

Lin²,

Xia³

et al. 2004

WJG

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AIM:To evaluate the effect of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on the prognosis of hepatocellular carcinoma (HCC) patients with or without risk factors for the residual tumor. METHODS:From January 1995 to December 1998, 549 consecutive HCC patients undergoing surgical resection were included in this research. There were 185 patients who underwent surgical resection with adjuvant TACE and 364 patients who underwent surgical resection only. Tumors with a diameter more than 5 cm, multiple nodules, and vascular invasion were defined as risk factors for residual tumor and used for patient stratification. Kaplan-Meier method was used to analyze survival curve and Cox proportional hazard model was used to evaluate the prognostic significance of adjuvant TACE. RESULTS:In the patients without any risk factors for the residual tumor, the 1-, 3-, 5-year survival rates were 93.48%, 75.85%, 62.39% in the control group and 97.39%, 70.37%, 50.85% in the adjuvant TACE group, respectively. There was no significant difference in the survival between two groups (P = 0.3956). However, in the patients with risk factors for residual tumor, postoperative adjuvant TACE significantly prolonged the patients' survival. There was a statistically significant difference in survival between two groups (P = 0.0216). The 1-, 3-, 5-year survival rates were 69.95%, 49.86%, 37.40% in the control group and 89.67%, 61.28%, 44.36% in the adjuvant TACE group, respectively. Cox proportional hazard model showed that tumor diameter and cirrhosis, but not the adjuvant TACE, were the significantly independent prognostic factors in the patients without risk factors for residual tumor. However, in the patients with risk factors for residual tumor adjuvant TACE, and also tumor diameter, AFP level, vascular invasion, were the significantly independent factors associated with the decreasing risk for patients' death from HCC. CONCLUSION:Postoperative adjuvant TACE can prolong the survival of patients with risk factors for residual tumor, but can not prolong the survival of patients without risk factors for residual tumor.Ren ZG, Lin ZY, Xia JL, Ye SL, Ma ZC, Ye QH, Qin LX, Wu ZQ, Fan J, Tang ZY. Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor: A retrospective control study.

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“…Therefore it is reasonable to assume that intra-arterial administration of cytotoxic agents may facilitate the delivery of a higher therapeutic concentration to the tumor tissue [17]. Using meta-analyses and clinical study, Mathurin et al [18], Tanaka et al [19] and Fukuda et al [20] drew the conclusion that postoperative transarterial chemotherapy or TACE may improve the survival rate and reduce the recurrence rate. In the present study, although the log-rank test did not show a statistical difference between patients treated with operation and those with operation plus TACE, there is a tendency for improved survival of the latter.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Transhepatic Arterial Chemoembolization and Portal Vein Chemotherapy for Patients with Hepatocellular Carcinoma: A Randomized Study with 131 Cases

Wang

Sun³

et al. 2006

Dig Surg

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Objective: To explore the value of postoperative transarterial chemoembolization (TACE) and portal vein chemotherapy (PVC) in patients with hepatocellular carcinoma (HCC) in the prevention of recurrence, and to evaluate prognostic factors in a randomized study. Method: 131 patients with HCC were randomly divided into 3 groups: operation only (group A, n = 45); operation plus TACE (group B, n = 39), and operation plus TACE and PVC (group C, n = 47). Disease-free survival rates as well as prognostic factors were analyzed. Results: Most of the side effects and complications related to the operation, catheters and local chemotherapy were liver decompensation (16.1%), catheter obstruction (12.9%), and nausea and loss of appetite (25.8%), respectively. The disease-free survival curves were significantly different between the 3 groups as estimated by the Kaplan-Meier method (p < 0.05). Group C had a significantly higher disease-free survival rate compared to group A (p < 0.05). But no statistical differences were found between groups A and B and groups B and C (both p > 0.05). Tumor number and treatment modalities were independent prognostic factors for HCC patients (p < 0.05). Conclusion: Postoperative TACE combined with PVC may benefit the survival of patients with HCC. In specialized medical centers, aggressive methods such as TACE and PVC should be attempted on HCC patients without contraindications.

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Surgical resection combined with chemotherapy for advanced hepatocellular carcinoma with tumor thrombus: Report of 19 cases

Cited by 83 publications

References 19 publications

Treatment of Hepatocellular Carcinoma: A Systematic Review

Treatment of Hepatocellular Carcinoma: A Systematic Review

Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor: A retrospective control study

Postoperative Transhepatic Arterial Chemoembolization and Portal Vein Chemotherapy for Patients with Hepatocellular Carcinoma: A Randomized Study with 131 Cases

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