Contraindication For Liver Resection Research Articles

Impact of tumor size on the outcomes of hepatic resection for hepatocellular carcinoma: a retrospective study

BackgroundTo evaluate the impact of tumor size on the perioperative and long-term outcomes of liver resection for hepatocellular carcinoma (HCC).MethodsWe reviewed the patients’ data who underwent liver resection for HCC between November 2009 and 2019. Patients were divided into 3 groups according to the tumor size. Group I: HCC < 5 cm, Group II: HCC between 5 to 10 cm, and Group III: HCC ≥ 10 cm in size.ResultsThree hundred fifteen patients were included in the current study. Lower platelets count was noted Groups I and II. Higher serum alpha-feto protein was noted in Group III. Higher incidence of multiple tumors, macroscopic portal vein invasion, nearby organ invasion and presence of porta-hepatis lymph nodes were found in Group III. More major liver resections were performed in Group III. Longer operation time, more blood loss and more transfusion requirements were found in Group III. Longer hospital stay and more postoperative morbidities were noted in Group III, especially posthepatectomy liver failure, and respiratory complications.The median follow-up duration was 17 months (7–110 months). Mortality occurred in 100 patients (31.7%) and recurrence occurred in 147 patients (46.7%). There were no significant differences between the groups regarding recurrence free survival (Log Rank, p = 0.089) but not for overall survival (Log Rank, p = 0.001).ConclusionHCC size is not a contraindication for liver resection. With proper selection, safe techniques and standardized care, adequate outcomes could be achieved.

Impact and outcomes of liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension.

Clinically significant portal hypertension (CSPH), although not a contraindication for liver resection in cirrhosis, is considered a determinant prognostic factor for post-surgical outcomes. This study aims to investigate the effects of CSPH on short and long-term results after hepatic resection for hepatocellular carcinoma (HCC). Single-center retrospective analysis of 126 consecutive hepatic resections for HCC in Child-Pugh A patients, performed between 2008 and 2018. Patients were divided according to the presence of CSPH, defined as a hepatic venous pressure gradient ≥ 10 mmHg. To overcome selection bias, 42 patients with CSPH were matched through propensity score with 42 patients without CSPH. Intraoperative and post-operative outcomes, along with overall and disease-free survival, were compared between the matched groups. Liver decompensation was four-fold in the CSPH group (28.6% vs. 7.1%, p = 0.010), while rate of severe complications, including 90-days mortality, was not statistically different between patients with and without CSPH. Overall and recurrence-free survival was not inferior in patients with CSPH compared to non-CSPH group. The present study has demonstrated acceptable outcomes of liver resection for HCC in carefully selected Child-Pugh A cirrhotic patients, even in the presence of elevated portal pressure.

Liver resection after Transjugular Portosystemic Stent Shunt (TIPSS).

Hepatocellular carcinoma (HCC)often arises in cirrhotic livers. Generally, decompensated liver cirrhosis is a contraindication to surgery. Even in compensated liver cirrhosis, liver resection for HCC carries a high risk of post-hepatectomy liver failure and decompensation of cirrhosis. Thus, in current staging systems such as the Barcelona Classification of Liver Cancer (BCLC) or the Hong Kong Classification of Liver Cancer (HKLC), liver resection is limited to smaller tumors in compensated cirrhosis. While transjugular portosystemic stent shunts (TIPSS) are widely used for the treatment of complications of portal hypertension such as recurrent esophageal bleeding or refractory ascites, the presence of a TIPSS is generally considered a contraindication for liver resection. Herein, we describe - to our knowledge for the first time - liver resection of an intermediate HCC with a diameter of 11 cm in a patient who had previously received a TIPSS for decompensated cirrhosis. With open surgery, radical resection (R0) was able to be achieved, and the patient left the hospital after 6 days following an uncomplicated postoperative course. Thus, in highly selected cases, liver resection following TIPSS may be considered.

Complex liver resection in the absence of portal vein bifurcation

• Absence of portal vein bifurcation is not a contraindication for liver resection • Complete study of portal, arterial and biliary anatomy is mandatory • Alternative technique to perform liver resection in this condition is presented

Is there Something New in 2021 in the Resection of Liver Metastases from Colorectal Cancer Involving the Inferior Vena Cava?

Purpose: Liver resection remains the only potentially curative treatment for metastatic tumours of the liver. In the past, suspected involvement of inferior vena cava (IVC) was considered a contraindication for liver resection. The developement of technical innovations have made it possible to perform combined liver and IVC resections andfavourable clinical outcomes have been reported. We conducted a systematic review of the literature on this topic.

Surgery of colorrectal liver metastases involving the inferior vena cava

Background: Liver resection remains the only potentially curative treatment for metastatic tumours of the liver. In the past, suspected involvement of inferior vena cava (IVC) was considered a contraindication for liver resection. The developement of technical innovations have made it possible to perform combined liver and IVC resections and favourable clinical outcomes have been reported. Material & Methods: A systematic review of the literature is performed to evaluate the safety and efficacy of combined liver and IVC resection in patients with colorrectal liver metastases involving IVC. Results: A total of 151 patients were described in 16 articles eligible. The studies were observational. Mean age was 58 years (range 35-84). We included 66 men and 53 women (2 studies did not include the sex). The mean number of resected metastases was 2.2 (range 1-27). The most frequent hepatic resections were: 36 right hepatectomies, 21 right trisectionectomies, 21 segmentectomies, 10 left hepatectomies, 8 extended right hepatectomies, 7 extended left hepatectomies, and 6 left trisectionectomies. In 3 cases diaphragm was resected, in 3 the right adrenal gland and in 1 the right kidney. The most performed types of vascular control were: total vascular exclusion in 63 cases, lateral clamping in 42 cases, and total vascular exclusion with hepatic hypothermic perfusion in 6 cases. Postoperative morbidity was 45.6%, mortality was 4.5%. Survival at 3 and 5 years was 55.6% and 32%. The mean follow-up was 22.7 months, and the median disease-free time was 10.5 months. Conclusions: Technical surgical advances allow the increasing resection of patients with liver metastases of colorectal cancer involving IVC. Published perioperative morbidity and mortality are comparable to the data published for this type of tumors without involvement of IVC. In the absence of prospective randomized studies, the IVC resection is safe and feasible in high-volume centers.

Caudate lobe malignant tumour: proposal of the morphological classification and correspondent liver resection

Introduction: Caudate lobe resection is a difficult and challenging operation even with hepatobiliary surgeons because of its deep location in the hepatic parenchyma and vascular involvement (beneath the root of hepatic veins, above the confluence of hepatic pedicle and in front of the inferior vena cava). Caudate lobe resection may be performed in isolation (partial or complete) or in combination with other portions of the liver depending on its size, location and vascular involvement. Method: From 2004 to 2018, There were 23 patients of caudate lobe tumour resected. Among these, 14 patients resected due to malignant solitary tumour (12 hepatocellular carcinoma patients, 1 cholangiocarcinoma patient and 1 colorectal liver metastasis patient). We morphologically classified the caudate lobe malignant solitary tumour into 5 types, illustrated with the correspondent liver resection (images and videos) and evaluated postoperative result. Result: Type 1: Tumour located in Spiegel lobe (7 patients), Type 2: Tumour located in S1r or S1c, without invading to right or left glissonean pedicle and 3 hepatic veins (2 patients), Type 3 (Subtype A, B, C): Tumour located in S1r or S1c, without invading to right or left glissonean pedicle but invading to hepatic veins (4 patients), Type 4: tumour located in S1r or S1c invading to right or left glissonean pedicle (1 patient), Type 5: Tumour invading to both right and left glissonean pedicle – contraindication for liver resection. There were no major postoperative complications (bile leakage, hemorrhage, hepatic failure…). No postoperative blood transfusion. The average operation time and hospital stay was respectively 265 (110-350) minutes and 14 days (8-29 days). Conclusion: For radical liver resection, the resection of caudate lobe malignant tumour could be carried out the isolated caudate lobe resection (partial or complete) or in combination with other portions of liver and should be based on the location, size and vascular involvement.

Portal vein tumor thrombus should not be considered as a contraindication for liver resection

Hepatocellular carcinoma (HCC) is one of most frequently occurring cancers, approximately 12.5–39.7% of HCC patients associate with portal vein tumor thrombus (PVTT) at the time of diagnosis (1). These patients were belonging to the Barcelona clinic liver cancer stage C and usually associated with poor liver function, treatment difficultly and poor prognosis, the median survival time (MST) was 2.7 months for patients without any treatment (2). According to official guidelines, these patients are only recommended oral sorafenib for treatment, but the patient’s MST is only 5.5 months, and always accompany with many side effects, the quality of life of patients is poor (3). In recent years, many clinical studies have suggested that liver resection (LR) could prolong the survival time of PVTT patients. It means that the treatment of HCC patients with PVTT is not limited to sorafenib, breaking the conventional treatment to choose LR for PVTT patients may be able to benefit many selected patients. LR for the treatment of PVTT has been attempted in many Asian countries. However, due to the lack of large-sample, multi-center and prospective study, this treatment is still not widely recognized.

Portal vein tumor thrombus should not be considered as a contraindication for liver resection

Portal vein tumor thrombus should not be considered as a contraindication for liver resection

Liver resection in the elderly: A retrospective cohort study of 460 patients – Feasible and safe

IntroductionThe aim of this study was to determine the influence of age on the early postoperative outcome after liver surgery. Material and methodsBetween January 2005 and July 2012 460 hepatic resections were performed in patients aged 60 years or younger and 70 years or older at the University Hospital Aachen and University Hospital Maastricht. The postoperative outcome of hepatic resection was evaluated by the time of intensive care unit (ICU) stay, length of hospital stay, appearance of postoperative complications and in-hospital mortality. ResultsThe median postoperative hospital stay was 7 days in group ≤60 and 8 days in group ≥70 (p = 0.007). The median time of ICU stay was 1 day in both groups. There were no statistically significant differences according to liver related complications. In group ≥70, significantly more patients suffered from pneumonia (8% vs. 2% in group ≤60, p = 0.015). The overall mortality rate was 3.5%. ConclusionAge alone should not be a contraindication for liver resection. However, elderly patients who develop pneumonia are at high risk for postoperative mortality. Therefore, factors such as short time of invasive ventilation, direct and intensive respiratory therapy and mobilization are of particular importance and should be focused on even more.

Liver Resection in the Elderly: Significance of Comorbidities and Blood Loss

ObjectiveLiver resection is increasingly performed in elderly patients who are suspected of increased postoperative morbidity (PM) and reduced overall survival (OS). Patient selection based on the identification of age-adjusted risk factors may help to decrease PM and OS. Design and ParticipantsProspectively collected data of 879 patients undergoing elective hepatic resection were analyzed. This population was stratified into three age cohorts: >70 years (n = 228; 26 %), 60–69 years (n = 309; 35 %), and <60 years (n = 342; 39 %). Multivariate survival analysis was performed. ResultsThe incidence of severe (p < 0.01) and non-surgical (p < 0.001) postoperative complications was higher in older compared to younger patients. Major estimated blood loss (EBL; p = 0.039) and comorbidities (p = 0.002) independently increased PM. EBL was comparable between all age cohorts. However, preexisting comorbidities, major EBL, and postoperative complications markedly decreased OS in contrast to younger patients. Adjusted for age, independent predictors of OS were comorbidities (HR = 1.51; p = 0.001), major hepatectomy (HR = 1.33; p = 0.025), increased EBL (HR = 1.32; p = 0.031), and postoperative complications (HR = 1.64; p < 0.001). ConclusionAlthough increased age should not be a contraindication for liver resection, this study accents the avoidance of major blood loss in elderly patients and a stringent patient selection based on preexisting comorbidities.

Advanced age is not a contraindication for liver resection in cases of large hepatocellular carcinoma

The role of surgery in the management of large hepatocellular carcinomas (HCCs) is controversial. Advanced age and comorbidities are taken into account when major surgery is considered. To compare the outcomes of liver resection (LR) and transarterial chemoembolization (TACE) for resectable HCC in patients aged 70 years or older. This study included 70 patients aged 70 years or older treated for large HCCs (≥5 cm) between January 2007 and December 2012: 37 underwent LR and 33 underwent TACE. The outcomes of these patients were retrospectively analyzed. Univariate and multivariate Cox proportional hazard models were established. Kaplan-Meier survival curves were generated, and survival data were compared using the log-rank test. Hospital stay was significantly longer in the LR group than in the TACE group (10 days vs 8.5 days; P = 0.003). Treatment-related complications were more frequent in the TACE group, but this difference was not statistically significant. LR was associated with a better disease-free survival rate, median survival rate and cumulative overall survival rate. Our results showed that LR could be a safe and effective treatment option for HCC tumors ≥5 cm in patiets aged 70 years or older.

Liver Resection for Colorectal Metastases: Is There an Age Limit? The Japanese Perspective

Liver resection is the only cure-oriented strategy for colorectal liver metastases, even in elderly patients. In the literature, there are no significant differences in overall survival and disease-free survivals between the elderly and the younger patients, who underwent liver resection, immediately or after preoperative chemotherapy. Morbidity and mortality rates are slightly increased in the elderly. Careful preoperative evaluation and postoperative monitoring is essential to improve patients’ survival. Patient selection should be discussed on a case-by-case basis by a multidisciplinary team. Older age is not a contraindication for liver resection.

654 GENETIC PREDISPOSITION OF HAND-FOOT SKIN REACTION FOLLOWING SORAFENIB THERAPY IN KOREAN PATIENTS WITH HEPATOCELLULAR CARCINOMA

Multipolar radiofrequency ablation (MRFA) is a new technique that could allow ablation of large volumes, using multiple bipolar electrodes. The purpose of this retrospective study is to report tolerance and 3-years results in patients with hepatocellular carcinoma (HCC) treated by this technique from to April 2004 to April 2010. Among 54 consecutively enrolled patients (44 male, median age 70 years (42–89) 48 had cirrhosis Child–Pugh A (39), or B (9), 6 had chronic liver disease without cirrhosis Serum AFP was >200ng/ml in 11 patients. The tumors were bi or trifocal in 9 cases, 8 were subcapsular, 4 were associated with segmental portal vein thrombosis 7 were infiltrative. The median size of the larger tumor was 6 cm in diameter (5–10). All patients presented contraindication for liver resection, 49 were naive, 5 were recurring after previous resection (n =3) or RFA (n =2). MRFA was performed under general anesthesia by the same operator using up to 6 bipolar electrodes under US guidance. Patients were closely followed every 3 months by US and CT/MRI and serum AFP determination, Kaplan–Meier curves were used for estimation of survival rate The mean follow-up was 17 months. A complete ablation was obtained in 47 patients (87%) after one (43), 2 (3) or 3 (1) sessions. Six of the seven patients with primary failure had infiltrative tumors. No mortality was observed, 7 patients experienced severe but resolving side effects icterus (3), pleural effusion requiring punction (2), liver abscess (1), biliary tract injury with anicteric cholestasis (1). At the end point, 22 patients developed local (5) or distant (22) recurrences, 18 patients died (13 of HCC progression) and 2 patients were transplanted. The overall 3-year recurrence rate was 65%. Among naive patients, the 3-year survival rate was 60% (median follow-up 20 months). We conclude that well limited HCC (>5 cm in diameter) even if associated with 1 to 2 satellite tumoral nodule or segmental portal thrombosis could be treated by MRFA with good results. Infiltrative tumors are contra indication due to the high rate of failure.

Intrahepatic Cholangiocarcinoma and Combined Hepatocellular-Cholangiocarcinoma: A Western Experience

Intrahepatic cholangiocarcinoma (ICC) is an unusual tumour. The clinicopathological data of 67 patients with ICC and combined hepatocellular-cholangiocarcinoma (HCC-ICC) are presented. HCV-HBV infection was present in 37.3% and chronic liver disease in 38.7% of cases, a rate higher than in the normal population; in these patients the cancer was small, often asymptomatic and of combined type. Liver resection was performed in 51 patients; at 1, 3 and 5 years, overall survival was 87.9%, 59.0%, and disease-free survival was 47.7% and 78.8%, 51.4%, and 46.7%, respectively. The better results were in the group of cirrhotic patients in whom ICC was diagnosed by a screening program for HCC (5-year survival 76.6%). Nodal metastasis showed negative prognostic value for both overall and disease-free survival; in N+ patients mean survival was 14.7 months after liver resection and lymph node dissection. Viral infection and cirrhosis may be considered risk conditions for ICC and combined HCC-ICC; in resected patients survival was good. Nodal metastases must not be considered a contraindication for liver resection.

Is chemotherapy failure a contraindication for liver resection in liver metastases of colorectal cancer? A multivariate analysis

4066 Background: Liver resection is the only curative treatment offering a chance of long-term survival in patients with colorectal liver metastases. Chemotherapy is increasingly proposed as neoadjuvant treatment in patients with irresectable liver metastases. However, a large number of patients show progress while on chemotherapy. Recent data indicated that liver resection in patients receiving chemotherapy with tumor progress is associated with poor outcome. The aim of the study was to identify risk factors for poor outcome in patients with preoperative chemotherapy with resectable colorectal liver metastases (CRM). Methods: We retrospectively analyzed the outcome of 168 consecutive patients who underwent liver resection for CRM after systemic chemotherapy between 1995 and 2004. Overall, 132 (78.6%) patients had first line, 24 (14.3%) patients second line and 12 (7.2%) third or fourth line chemotherapy. Three groups of patients were identified according to the chemotherapy response. 48 patients (28.6%) had a tumor response (group 1), in 20 (11.9%) the condition stabilized (group 2), and 100 (59.5%) patients had tumor progression (group 3). Median follow-up was 1.8 yrs (range (6 days - 9.5 yrs). Results: Demographic data, size of largest node, number of nodes, extent of resection and postoperative course were equally distributed between groups. Overall, survival was 89%, 56%, and 31% at 1, 3, and 5 years, respectively. Five-year survival was similar between groups. In the univariate analysis, only incomplete resection and vascular invasion were associated with poor outcome. In the multivariate analysis, only vascular invasion was significantly associated with fatal outcome. Neither the number of lines nor the chemotherapeutic agent was associated with decreased survival. Conclusions: In a large patient population, liver resection offered long-term survival for patients with multiple colorectal metastases, even in cases with tumor growth whilst receiving chemotherapy. This underlines that, whenever a curative resection is possible, surgical resection of liver metastases is justified even in patients with therapy failure due to chemotherapy. No significant financial relationships to disclose.