Hepatectomy For Large Hepatocellular Carcinoma Research Articles

Central hepatectomy for large hepatocellular carcinoma

Central hepatectomy for large hepatocellular carcinoma

Laparoscopic versus open hepatectomy for large hepatocellular carcinoma: a single center propensity-score-matching comparative analysis of perioperative outcomes and long-term survival.

Although the benefits of laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC) in most circumstances are evident, the benefits for large HCC are contentious. This study aimed to compare the perioperative outcomes and survival after LH versus open hepatectomy (OH) in large HCC patients. An analysis of prospectively maintained database included 215 hepatectomies for large HCC (diameter ≥ 5cm). The operative and survival outcomes were compared between the LH group (n = 109) and the OH group (n = 106). Propensity score matching (PSM) 1:1 included 70 patients in each group. The entire cohort multivariable analyses were performed to identify the factors associated with surgical complications and suboptimal recurrence-free survival (RFS). After PSM, baseline characteristics and the extent of liver resection were similar in both groups. The LH group had a shorter hospital stay than the OH group (7 vs 9.5days, p = 0.001). The R0 resection rate, complication rate, overall survival, and RFS were similar between the groups. The multivariate analyses revealed two independent factors predicting surgical complication (major resection; p < 0.001 and large volume blood loss; p = 0.042), and 3 independent factors predicting suboptimal RFS including R1 resection (p = 0.011), multifocal HCC (p = 0.005), and microvascular invasion (p = 0.001). LH was not associated with surgical complication and suboptimal RFS. Our study highlights the benefits of LH by improving the perioperative outcomes, without long-term survival inferiority in selected large HCC patients compared with conventional OH. LH can be an attractive option for large HCC treatment.

Impact of Tumor Size as a Prognostic Factor After One Stage Liver Resection for Solitary Hepatocellular Carcinoma in Cirrhotic Patients

Aim: This study is to assess tumor size as a prognostic factor predicting outcomes after one staged hepatectomy for cirrhotic patients with solitary hepatocellular carcinoma. Patients and methods: The study included 41 patients with single hepatocellular carcinoma (HCC) of different sizes who underwent single-stage hepatectomy. Patients were divided according to their tumor size into 2 groups, group A involved patient with tumors ≤ 5 cm and group B which involved patients with tumors > 5 cm. The effect of the tumor size on overall survival and disease-free survival was studied in both groups. Results: The mean age of the studied groups was 59.60±6.89 years. Hepatitis C infection was found 82.9% of patients. Six patients (17.1%) received treatment of HCV. All patients were of Child-Pugh class A (77.1% were scores 5 and 22.9% were score 6). The median Alpha-fetoprotein (AFP) level was 240 ng/ml. The mean operative time was 186.4±52.4 min. During the follow-up period (12-24 months), 12 patients (34.3%) developed recurrence. The mean time of recurrence was 15.50±4.23 months. Cumulative disease-free survival (DFS) at the end of the study was 65.7%. The cumulative overall survival (OAS) proportion at the end of the study was 74.3%. Conclusion: Our results suggest that surgical resection for large HCC is safe and effective and that the first-line treatment for large HCC to be considered is surgical resection in selected patients. Our study showed that hepatectomy for large HCC could be performed with an acceptable morbidity and mortality rate. With the improvement in patient selection and treatment strategy, solitary large HCC is not a contraindication to surgical therapy.

Sequential transcatheter arterial chemoembolization and portal vein embolization versus portal vein embolization alone before major hepatectomy for patients with large hepatocellular carcinoma: An intent-to-treat analysis

BackgroundLittle is known about the value of sequential transcatheter arterial chemoembolization and portal vein embolization compared with portal vein embolization alone before major hepatectomy for large hepatocellular carcinoma. We aimed to compare early and long-term outcomes of these two strategies. MethodsWe included all consecutive patients with large hepatocellular carcinoma (≥50 mm) scheduled for sequential transcatheter arterial chemoembolization and portal vein embolization or portal vein embolization alone before major hepatectomy from January 2005 to December 2015. Comparisons were made on an intent-to-treat basis. ResultsA total of 55 patients were included as follows: sequential transcatheter arterial chemoembolization and portal vein embolization (n = 27) and portal vein embolization alone (n = 28). Baseline patient and tumor characteristics were similar in the 2 groups. Downstaging after transcatheter arterial chemoembolization changed the initial strategy in 4 patients who finally underwent liver transplant (n = 1) and limited hepatectomy (n = 3). Overall survival and progression-free survival were better in the transcatheter arterial chemoembolization group compared with the portal vein embolization alone group (3-year overall survival of 60% vs 20%; P = .01 and 3-year progression-free survival of 35% vs 0%; P < .001). The proportion of patients who finally underwent hepatectomy after transcatheter arterial chemoembolization plus portal vein embolization was 91% vs 68% after portal vein embolization alone (P = .08). Hypertrophy of the future remnant liver after portal vein embolization was greater after transcatheter arterial chemoembolization (43% vs 31%, P = 0.03). After resection, the group that received transcatheter arterial chemoembolization and portal vein embolization experienced better progression-free survival compared with portal vein embolization alone (3-year progression-free survival of 28% vs 0%; P = .03). ConclusionOur results suggest that transcatheter arterial chemoembolization before portal vein embolization increases the degree of hypertrophy of the future remnant liver after portal vein embolization and yields improved oncologic outcomes in patients with large hepatocellular carcinomas planned for major hepatectomy.

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.

A comparative study of anterior versus conventional approach right hepatectomy for large hepatocellular carcinoma

To compare the outcomes between anterior versus conventional approach right hepatectomy for large hepatocellular carcinoma (HCC). A total of 188 consecutive patients with large HCC ( > or =5 cm) undergoing right hepatectomy were reviewed retrospectively. Among them, 92 patients received anterior approach right hepatectomy (anterior group) while the other conventional right hepatectomy (conventional group). Their clinicopathologic data and survivals were compared. There were five surgical deaths (2.7%), two in the anterior group and three in the conventional group. The biochemical and tumor pathological data (except for tumor size) of these two groups were comparable. The mean intraoperative blood loss, the number of patients with massive hemorrhage ( >3000 ml) and the volume of blood transfusion of the anterior group were markedly less than those of conventional group. The 1-, 3-year disease-free survival rates of the anterior group were significantly better than those of the conventional group (56.2%, 30.9% vs. 39.1%, 13.0%, P = 0.043). The 1- & 3-year cumulative survival rates of the anterior group were also markedly higher than those of conventional group. The Cox regression model indicated that tumor size [P = 0.014, odd ratio (OD) = 1.074] and surgical procedure (P = 0.009, OD = 0. 468) were independent risk factors correlated with disease-free survival. And the surgical procedure (P = 0.003, OD = 0.369) was the only independent risk factor for postoperative cumulative survival. Anterior approach right hepatectomy can significantly decrease intraoperative blood loss. The postoperative survivals of large HCC patients are significantly improved by anterior approach right hepatectomy.

Factors associated with recurrence and survival following hepatectomy for large hepatocellular carcinoma: A multicenter analysis

Optimal management of large (>5 cm) hepatocellular carcinoma (HCC) remains controversial. We sought to determine the factors associated with recurrence and survival for patients with large HCC following hepatectomy. An analysis of a combined prospective database from two tertiary care centers was performed on consecutive patients who underwent hepatectomy for HCC > 5 cm. Univariate and multivariate analyses were performed to determine factors associated with recurrence, disease-free (DFS) and overall survival (OS). Seventy-eight patients were identified: 32 (41%) had hepatic fibrosis. Forty-six patients (59%) underwent a major hepatectomy with a morbidity rate of 41% and a mortality rate of 13%. Fibrosis was associated with male gender (P = 0.045), hepatitis C (P = 0.003), higher Child-Pugh (P < 0.0001) and Okuda score (P = 0.002), smaller tumors (6.25 cm vs. 10.5 cm; P < 0.001), positive-margin resection (P = 0.01), and death (P = 0.047). Factors associated with recurrence include tumor multifocality (P = 0.03) and vascular invasion (P = 0.02). Predictors of OS include multifocal tumors (P = 0.05), margin status (P = 0.02), vascular invasion (P = 0.01), and treatment complications (P = 0.004). The median overall DFS and OS were 12 and 20 months, respectively. Fibrosis had no impact on DFS (P = 0.24) or OS (P = 0.20). For patients with HCC larger than 5 cm, tumor-related factors predict outcomes and survival.

Effects of blood transfusion on short-and long-term prognosis of patients following hepatectomy for large hepatocellular carcinoma

目的 研究输血对大肝癌切除术后近期并发症和远期存活率的影响.方法 回顾性分析177例大肝癌切除术病例,结合随访分析输血对近期并发症和远期存活率的影响.结果 本组大肝癌围手术期输血率为74.6%.近5年输血量及输血率较5年前显著减少(P＜0.01).不输血组并发症率低于输血组(P＜0.05).单因素分析显示,年龄、肝门阻断、术中出血量、输血量以及手术时间与术后并发症发生有关.多因素分析显示,年龄、肝门阻断、输血量以及手术时间是决定术后并发症的4个独立的预测指标.本组大肝癌1、3、5年总存活率为67%、44%和34%,1、3、5年无瘤存活率为51%、31%和31%.不输血组和输血组的总存活率以及无瘤存活率无显著差别.结论 输血是决定大肝癌切除术后并发症发生的独立危险因素之一,但输血对大肝癌切除术后存活率无显著影响.肝脏外科医生应积极采取各种方法尽可能避免大肝癌切除术围手术期的输血。

Long-term results of resection for large hepatocellular carcinoma: A multivariate analysis of clinicopathological features

Recurrent or metastatic disease is frequently encountered among patients who have had resection of their primary hepatocellular carcinoma. A retrospective study on 117 patients (104 men, 13 women; mean age +/- standard deviation: 53.8 +/- 12.4 yr) who had hepatectomy for large hepatocellular carcinoma (diameter greater than or equal to 5 cm) was conducted to identify an at-risk population for tumor recurrence. Disease-free survival was correlated with 22 clinical (n = 5), serological (n = 2), gross pathological (n = 3) and histological (n = 12) features of the resected specimens using Cox's multivariate regression analysis. Recurrent hepatocellular carcinoma was detected in 74 patients within a median follow-up period of 13.7 mo. Although 17 patients had extrahepatic disease alone, recurrence was confined to the hepatic remnant in 40 patients. Disease-free survival rates at 1, 3 and 5 yr were 40%, 19% and 12%, respectively. Two of the five histological parameters isolated, negative resection margin (p less than 0.01) and encapsulation (p less than 0.006), were identified as favorable independent prognostic predictors. When patients with positive margins were excluded from the analysis, repeated calculation showed that encapsulation was the only important determinant. From this analysis, detailed histological study of the resected tumor is seen to be the only satisfactory means for assessing long-term prognosis. An aggressive approach is warranted among patients with encapsulated tumors. Even with a clear resection margin, adjuvant treatment should be considered for those patients who have unencapsulated lesions.