Hepatectomy For Huge Hepatocellular Carcinoma Research Articles

Laparoscopic vs. open hepatectomy for huge hepatocellular carcinoma: a propensity score matched retrospective analysis of short- and long-term outcomes

Laparoscopic vs. open hepatectomy for huge hepatocellular carcinoma: a propensity score matched retrospective analysis of short- and long-term outcomes

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

BackgroundHepatectomy 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.MethodsWe 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.ResultsThe 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.ConclusionsThe 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.

Two novel online nomograms for predicting the survival of individual patients undergoing partial hepatectomy for huge hepatocellular carcinoma

BackgroundA method for predicting prognosis of patients who undergo partial hepatectomy for huge hepatocellular carcinoma (HHCC, diameter ≥10 cm) is currently lacking. This study aimed to establish two online nomograms to predict the overall survival (OS) and disease-free survival (DFS) for patients undergoing resection for HHCC. MethodsThe clinicopathologic characteristics and follow-up information of patients who underwent partial hepatectomy for HHCC at two medical centers were reviewed. Using a training cohort, a Cox model was used to identify the predictors of survival. Two dynamic nomograms for OS and DFS were developed and validated based on the data. ResultsEight and nine independent factors derived from the multivariate analysis of the training cohort were screened and incorporated into the nomograms for OS and DFS, respectively. In the training cohort, the nomogram achieved concordance indices (C-indices) of 0.745 and 0.738 in predicting the OS and DFS, respectively. These results were supported by external validation (C-indices: 0.822 for OS and 0.827 for DFS). Further, the calibration curves of the endpoints showed a favorable agreement between the nomograms’ assessments and actual observations. ConclusionsThe two web-based nomograms demonstrated optimal predictive performance for patients undergoing partial hepatectomy for HHCC. This provides a practical method for a personalized prognosis based on an individual's underlying risk factors.

The hepatectomy efficacy of huge hepatocellular carcinoma and its risk factors: A meta analysis.

Background:There has always been a controversy on the hepatectomy for huge hepatocellular carcinoma (HCC). Therefore, we aim to explore the hepatectomy efficacy of huge HCC and its risk factors.Methods:A systematic research was performed using PubMed, MedLine, Web of Knowledge, and Cochrane Library from their establishment to August 2017. The major endpoints were overall survival (OS) rate and recurrence-free survival (RFS) rate, and the secondary ones were the morbidity of complications and mortality of hepatectomy.Results:About 13 studies with a total of 7609 patients were included in this meta-analysis. The hepatectomy efficacy of huge HCC was inferior to non-huge HCC both in OS (hazard ratio [HR] = 2.18, 95% confidence interval [CI] = 1.90–2.50, P < .00001; I2 = 66%, P = .003) and RFS (HR = 1.97, 95% CI = 1.76–2.19, P < .00001; I2 = 74%, P = .0001). However, the risk difference[RD] of the 1-year, 3-year and 5-year OS tended to be acceptable (RD = −0.05, 95% CI = −0.11–0.00, P = .05; RD = −0.13, 95% CI = −0.21–−0.05, P = .002; RD = −0.10, 95% CI = −0.19–−0.01, P = .03; respectively). Moreover, there were also no significant differences between huge HCC and non-huge HCC in the morbidity of complication and mortality of hepatectomy (RD = 0.07, 95% CI = −0.09–0.23, P = .38; RD = −0.01, 95% CI = −0.00–−0.03, P = .06; respectively). Related risk factors were measured to explore the differences, and the results showed that the level of alpha fetal protein (AFP) and the margin-positive rate were higher (standard mean difference [SMD] = 0.57, 95% CI = 0.26–0.88, P = .0003; odd radio[OR] = 32.52, 95% CI = 1.02–6.22, P = .04; respectively), the characteristic of huge HCC tended to be worse such as lower clinical or pathological stage, incomplete capsule and incorporate satellite metastases (OR = 2.91, 95% CI = 1.68–5.04, P = .001; OR = 3.99, 95% CI = 3.40–4.67, P < .00001; OR = 2.52, 95% CI = 1.66–3.83, P < .0001; respectively), and the rate of micorvascular invasion (MVI) including portal vein tumor thrombus (PVTT) were higher (OR = 3.36, 95% CI = 1.61–7.02, P = .001; OR = 2.75, 95% CI = 2.29–3.31, P < .00001; respectively) in the huge HCC.Conclusion:The hepatectomy efficacy of huge HCC was inferior to non-huge HCC, but its survival benefits and feasibility were confirmed in this meta-analysis. In addition, higher level of AFP, positive margin, lower clinical or pathological stage, incomplete capsule, incorporate satellite metastasis and MVI were significantly correlated with poor OS.

496 - Caudate Lobectomy with Extended Left Hepatectomy for Huge Hepatocellular Carcinoma in Caudate Lobe

496 - Caudate Lobectomy with Extended Left Hepatectomy for Huge Hepatocellular Carcinoma in Caudate Lobe

Safety assessment of hepatectomy for huge hepatocellular carcinoma by three dimensional reconstruction technique

To explore the effectiveness of three-dimentional(3D)reconstruction technique in safety assessment of hepatectomy for large hepatocellular carcinoma(HCC). The clinical records of 28 patients who underwent resection of HCC greater than 10 cm in diameter from January 2013 to December 2015 at Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology were studied retrospectively. All patients underwent enhanced computer tomography (CT), then 3D images of liver and tumor were reconstructed by uploading the CT imaging data to IQQA-Liver system. The individual surgery plan was simulated and liver volume (LV), standard liver volume(LV), tumor volume(TV), functional liver volume(FLV), excised liver volume(ELV), excised functional liver volume (EFLV), residual functional liver volume (RELV) were calculated. Simulated surgery plans were compared with actual procedures. ELV was compared with actual excised liver volume (AELV) by paired Student's t test. Postoperative complications and motility were analyzed. The correlation between TV and EFLV, RFLV, RFLV/FLV, RFLV/SLV were calculated by Spearman test. TV ranged from 202 cm(3) to 2 125 cm(3,) RELV ranged from 401 cm(3) to 1 633 cm(3).There were 13 patients whose RFLV/LV<30% and 28 patients whose RFLV/FLV>30%(34.8%-94.0%). RFLV/SLV ranged from 35.9% to 139.0%.All simulated surgery plans matched with the actual operation procedure. ELV was equal to AELV, which confirmed by the high precision of IQQA-Liver system(t=0.636, P>0.05). No severe complications (hepatic encephalopathy or liver failure) and perioperative death occurred after operation. Positive correlation was observed between TV and RFLV, TV and RFLV/FLV, TV and RFLV/SLV(r=0.641, 0.629 and 0.732, all P<0.01). Negative correlation was observed between TV and EFLV (r=-0.539, P<0.01). 3D reconstruction technique could accurately simulate surgery procedure, calculate liver volume and evaluate the safety of hepatectomy for huge hepatocellular carcinoma. When the anatomical liver resection was performed, the larger tumor volume means the smaller excision functional liver volume and larger residual liver volume.

Is hepatectomy for huge hepatocellular carcinoma (≥ 10 cm in diameter) safe and effective? A single-center experience.

This retrospective study aimed to validate the safety and effectiveness of hepatectomy for huge hepatocellular carcinoma (HCC). Data of patients who underwent hepatectomy for HCC between January 2006 and December 2012 were reviewed. The patients were divided into three groups: huge HCC(≥ 10 cm in diameter), large HCC(≥ 5 but<10 cm in diameter) and small HCC(<5 cm in diameter). Characteristics of pre-operative patients in all three groups were homogeneously distributed except for alpha fetal protein (AFP)(p<0.001).The 30, 60, 90-day post-operative mortality rates were not different among the three groups (p=0.785, p=0.560, and p=0.549). Laboratory data at 1, 3, and 7 days after surgery also did not vary. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) rates in the huge and large HCC groups were lower than that of the small HCC group (OS: 32.5% vs 36.3% vs 71.2%, p=0.000; DFS: 20.0% vs 24.8% vs 40.7%, p=0.039), but there was no difference between the huge and large HCC groups (OS: 32.5% vs 36.3%, p=0.667; DFS: 20.0% vs 24.8%, p=0.540). In multivariate analysis, five independent poor prognostic factors that affected OS were significantly associated with worse survival (p<0.05), namely, AFP level, macrovascular invasion, Edmondsone Steiner grade, surgical margin and Ishak score. AFP level, macrovascular invasion, microvascular invasion, and surgical margin influenced disease-free survival independently (p<0.05). The safety of hepatectomy for huge HCC is similar to that for large and small HCC; and this approach for huge HCC may achieve similar long-term survival and disease-free survival as for large HCC.

Outcome of Hepatectomy for Huge Hepatocellular Carcinoma.

PurposeIn spite of the recent improved results of hepatectomy for huge hepatocellular carcinomas (HCC), the prognosis of patients with huge HCCs is still poor compared to that of patients with small HCCs. This study was performed to compare the results of hepatectomy between patients with huge HCCs and those with small HCCs, to identify the prognostic factors in patients with huge HCCs, and to determine the preoperative selection criteria.MethodsWe retrospectively analyzed 51 patients who underwent hepatectomy, between July 1994 and February 2009 at Dankook University Hospital. Patients with HCC≥10 cm were classified in large (L) group and others were classified in small (S) group. The clinicopathological features, operative procedures, and postoperative outcome were compared between both groups and various prognostic factors were investigated in group L.ResultsEleven patients were classified in group L. Tumor size, vascular invasion, and tumor stage were higher in group L. Postoperative morbidity was higher in group L, but mortality was not different between the groups. Disease-free survivals were significantly lower in group L than in group S (36.4%, and 24.2% vs. 72.0%, and 44.0% for 1- and 3-year), but overall survival rates were similar in both groups (45.5%, and 15.2% in group L vs. 60.3%, and 41.3% in group S for 3- and 5-year). Presence of satellite nodules was the only prognostic factor in multivariate analysis after surgery for huge HCC.ConclusionRegardless of tumor size, huge HCCs deserve consideration for surgery in patients with preserved liver function. Furthermore, the effect of surgery could be maximized with appropriate selection criteria, such as huge HCC without satellite nodules.

Adaptation of hepatectomy for huge hepatocellular carcinoma

We retrospectively identified prognostic factors in patients with huge hepatocellular carcinoma (HCC) more than 10 cm in diameter and established a clinical strategy for such patients at our institution. Three-hundred and twenty patients with HCC underwent hepatectomy. Twenty-nine of them were diagnosed with HCC 10 cm or more in diameter (group L). Two hundred and ninety-one patients were diagnosed with HCC less than 10 cm (group S). The overall and disease-free survival rates in the two groups were compared, and the prognostic factors in group L were analyzed. The overall 3-and 5-year survival rates in group L were 33.6% and 33.6%, and these rates in group S were 61.4% and 45.0%, respectively. The difference between the two groups was significant (P=0.0048). The disease-free survival rates in group L (3-year, 21.5%; 5-year, 21.5%) were also significantly worse than those in group S (3-year, 37.1%; 5-year, 25.4%; P=0.0022). Background liver (cirrhosis vs no cirrhosis) (P=0.0380) and TNM stage according to the Liver Cancer Study Group of Japan (stage II or III vs stage IV; P=0.0308) were significantly associated with prognosis by multivariate analyses. Hepatic resection is a safe and effective treatment for huge HCC of more than 10 cm in diameter. However, we suggest that cirrhotic patients with huge HCC with the presence of both macrovascular invasion and multiple tumors may not be appropriate candidates for hepatic resection.

Hepatectomy for huge hepatocellular carcinoma in 634 cases

To clarify the safety and feasibility of hepatectomy for huge hepatocellular carcinoma (HCC). A total of 4765 patients with HCC operated at Tongji Hospital were retrospectively studied, of them, 780 patients had huge HCC (10 cm or more in diameter). Hepatectomy was carried out on 634 patients (81.2%). The majority of the liver resection were major resections, and combined resection of the adjacent organs or structures was common (17.2%). The liver resection was combined with portal vein thrombectomy in 139 patients (21.9%). Postoperative complications were common (26.8%) and required another laparotomy to prevent the complications in 5 patients (0.8%). The 30-d mortality was 2.2%. The main causes of postoperative deaths were liver failure (n = 9), postoperative bleeding (n = 4) and septic complication (n = 1). The 3-, 5- and 10-year survival rates after liver resection were 35.1%, 18.2% and 3.5%, respectively. Hepatectomy for huge HCC is safe and effective. It should be used to treat patients with low surgical risks and resectable tumours.

Chinese experience with hepatectomy for huge hepatocellular carcinoma.

The risks and outcome of hepatic resection for huge hepatocellular carcinoma (HCC) are controversial. The clinical records of 525 patients who underwent resection of HCC greater than 10 cm in diameter were studied retrospectively. Prognostic factors for long-term survival were evaluated by univariate and multivariate analyses. Postoperative complications were common (26.8 per cent) and five patients (0.9 per cent) required relaparotomy. The 30-day mortality rate was 2.7 per cent. The main causes of postoperative death were liver failure (nine patients) and bleeding (four). The 3-, 5- and 10-year crude survival rates after liver resection were 34.3, 16.8 and 2.9 per cent respectively. Prognostic factors for long-term survival mainly reflected the biological behaviour of the tumour. They can be used only as a guide in balancing the risks of operation against the potential benefits of resection in a patient in poor general condition or with poor liver function. They cannot be used alone to exclude patients from liver resection with curative intent. Liver resection for huge HCC was safe and efficacious. It should be used to treat patients with acceptable surgical risks and resectable tumours.