Surgical resection for hepatocellular carcinoma in pregnancy: A case report

Hung, Chih-Chiang; Wu, Cheng‐Chung; Cheng, Shao-Bin; Hsia, Jiun-Yi; Wang, John; Lui, Wing‐Yiu; P’eng, Fang-Ku

doi:10.1016/j.asjsur.2012.04.012

Cited by 8 publications

(10 citation statements)

References 9 publications

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“…Currently, repeat hepatectomy seems to be a better choice for recurrent HCC. However, no long-term survival after HCC recurrence during pregnancy has been reported in the literature [5]. Nonetheless, the present case survived without recurrence for approximately 2 years after the second hepatectomy for recurrent HCC and 5 years after the first hepatectomy.…”

Section: Discussionmentioning

confidence: 55%

“…HCC during pregnancy, which is believed to have a worse prognosis than that among non-pregnant woman, is extremely rare, with only 62 cases having been reported worldwide to date [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Accordingly, studies have shown an overall 6-month and 1-, 2-, and 3-year survival rates of 50%, 29.5%, 18.2%, and 13.6%, respectively, with a median survival of 18 months in pregnant patients with HCC [2].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the previous reports have revealed that 20% of the pregnant patients with HCC developed distant metastasis upon presentation [ 3 ]. Although hepatic resection has been the best potentially curative therapy for HCC [ 1 – 5 ], Choi et al [ 2 ] reported that only 16 of 48 pregnant mothers with HCC underwent liver resection. Currently, repeat hepatectomy seems to be a better choice for recurrent HCC.…”

Section: Discussionmentioning

confidence: 99%

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Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report

et al. 2020

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Background Hepatocellular carcinoma (HCC) during pregnancy is extremely rare. Treatment strategies for cancers detected during pregnancy have been controversial. We herein report a case of recurrent HCC detected at 20 weeks of pregnancy, which subsequently prompted hepatic resection after abortion. Case presentation A 36-year-old woman underwent laparoscopic partial hepatectomy for HCC (20 mm in diameter) in segment 5 of the liver during follow-up after being determined as a hepatitis B virus carrier two and a half years ago. Post-surgery follow-up abdominal ultrasonography revealed a 36-mm tumor in segment 7 of the liver. Abdominal contrast-enhanced computed tomography revealed a well-enhanced tumor with a 40-mm diameter in segment 7 adjacent to the inferior vena cava and right hepatic vein, suggesting HCC recurrence. Laboratory data revealed total bilirubin (0.4 mg/dL), aspartate aminotransferase (28 IU/L), alanine aminotransferase (30 IU/L), glutamyltransferase (16 IU/L), prothrombin time (115.3%), and indocyanine green retention rate at 15 min (7.0%). α-Fetoprotein (AFP) (12,371.5 ng/mL; normal range < 10 ng/mL) and PIVKA-II (208 mAU/mL; normal range < 40 mAU/mL) were both significantly elevated. After discussions with a cancer board consisting of experts from the departments of gastroenterology, obstetrics and gynecology, and surgery, as well as obtaining appropriate informed consent from the patient and her family, we decided to perform a hepatic resection after abortion. Subsequently, abortion surgery was performed at 21 weeks and 2 days of pregnancy. After 6 days, subsegmentectomy of liver segment 7 was performed under general and epidural anesthesia, with a pathological diagnosis which was moderately differentiated HCC being established. Given the good postoperative course, without particular complications, the patient was subsequently discharged 10 days after the operation. Approximately 2 years after the surgery, the patient remains alive without recurrence, while both AFP and PIVKA-II were within normal limits. Conclusions Treatment strategies for HCC detected during pregnancy remain controversial. As such, decisions should be made based on HCC growth and fetal maturity after thorough multidisciplinary team discussions and obtaining appropriate informed consent from the patient and her family.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report

et al. 2020

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“…Management during pregnancy may include hepatectomy 98,99 . Earlier diagnosis and active treatment have translated to modest improvements in survival for this small cohort 96 …”

Section: Specific Conditionsmentioning

confidence: 99%

Review article: chronic liver disease and pregnancy

Faulkes

Chauhan

Knox

et al. 2020

Aliment Pharmacol Ther

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“…It appears that the morbidity and mortality of HCC during pregnancy has improved over time as the diagnosis tended to be made earlier and patients tended to receive resection and other treatments. 6 El-Serat et al 7 reported that HCC were more aggressive with an overall one-year survival of only 23%. Pregnancy with HCC is believed to impart a worse prognosis than in non-pregnant women.…”

Section: Introductionmentioning

confidence: 99%

Surgery for pregnancy-associated primary hepatocellular carcinoma: Report of four cases

Zhou

Lü

et al. 2014

International Journal of Surgery Case Reports

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INTRODUCTIONHepatocellular carcinoma (HCC) occurring in pregnancy is quite rare. The prognosis is usually poor because of a delay in diagnosis. Reported cases of HCC in pregnancy are largely isolated with no large experience. Thus the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented. Our aim was to review our experience with management of four young pregnant women with HCC.PRESENTATION OF CASELaboratory tests were performed before surgery. We analyzed the effects of age, hepatitis B surface antigens status, cirrhosis at presentation, gestational age of fetus, and maternal outcome.DISCUSSIONIncrease in alpha-fetoprotein (AFP) level was somewhat useful for diagnosis. Three patients died in 5 months, 6 months, and 24 months from HCC recurrence, and another patient is alive without disease 12 months postoperatively.CONCLUSIONSurgery for HCC during pregnancy should be similar to that for non-pregnant women. Complete excision of tumor without termination of pregnancy provides the greatest chance of survival for women with HCC during pregnancy but depends on gestational age of the fetus. Adjuvant treatments are required to improve the long-term results of this type of surgery. The 28-week gestational week is a critical point of fetal maturation which is very important in deciding whether pregnancy should be terminated or not. The pregnancy was terminated in two of our patients when spontaneous rupture of HCC was diagnosed to save the mother's life.

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Surgical resection for hepatocellular carcinoma in pregnancy: A case report

Cited by 8 publications

References 9 publications

Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report

Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report

Review article: chronic liver disease and pregnancy

Surgery for pregnancy-associated primary hepatocellular carcinoma: Report of four cases

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