Repeat Hepatectomy For Patients Research Articles

Adjuvant hepatic arterial infusion pump chemotherapy after repeat hepatectomy for patients with liver confined recurrence of colorectal cancer – a phase ii study

Adjuvant hepatic arterial infusion pump chemotherapy after repeat hepatectomy for patients with liver confined recurrence of colorectal cancer – a phase ii study

Radiofrequency ablation compared with repeat hepatectomy for patients with recurrent hepatocellular carcinoma: A meta-analysis

The therapy of recurrent hepatocellular carcinoma (RHCC) remains poorly defined. Repeat hepatectomy (RH) and radiofrequency ablation (RFA) have offered as alternative therapy choices. Our study aims to assess survival benefits of RFA versus reresection for RHCC after resection. The electronic databases were used in order to explore the researches analyzing the efficacy of RH vs. RFA in treating RHCC updated to June 2020. After strict evaluation on quality, the interested results were extracted from articles. Totally, a total of 11 publications involving 1515 subjects were included, with 645 conducted RH and 870 taking RHA. We found that RH was associated with better 3-year OS (OR = 1.58, 95% CI = 1.22–2.05, P = 0.0005), while no difference with 1-year (OR = 1.03, 95% CI = 0.07–1.51, P = 0.90) or 5-year OS (OR = 1.66, 95% CI = 0.88–3.14, P = 0.12) in comparison with RFA for RHCC. In terms of DFS, RH was associated with better 3-year DFS (OR = 1.51, 95% CI = 1.11–2.06, P = 0.009) and 5-year DFS (OR = 1.54, 95% CI = 1.14–2.09, P = 0.005) than RFA. Moreover, RH had more morbidity compared with patients who underwent RFA for RHCC patients (OR = 5.61, 95% CI = 3.02–10.42, P < 0.00001). In conclusion, RH achieves better disease-free survival but with higher morbidity for RHCC than RFA. More researches are clearly required to further strengthen quality of results and standardize the method.

A Novel Scoring System for the Difficulty Level in the Lysis of Adhesions Around the Liver for Safe Repeat Hepatectomy in Patients with Hepatic Malignancies

Introduction: Repeat hepatectomy (ReHx) for recurrent hepatic malignancies reportedly provides oncological benefit for patients. However, severe adhesions at ReHx may preclude safe and curative resection and there has been no reliable measure to estimate the surgical risk at ReHx. This study sought to create a new scoring system for evaluating the severity of adhesion after hepatectomy and tested its performance looking at the correlation with morbidity rate. Methods: 66 operative videos of second hepatectomy were reviewed and the difficulty levels in lysis of adhesion around the hepatic hilum (A score) and surrounding the liver (B score) were scored by two examiners and validated by additional two reviewers. Results: Very high interobserver agreement was confirmed between the two examiners (k value, 0.960-0.963) and reproducibility of results were validated with weighted kappa values of >0.8 in both surgical resident and hepatobiliary surgery. Linear correlation was confirmed between the difficulty score and postoperative morbidity rate. Multivariate analyses confirmed that previous cholecystectomy or transection of visceral surface of segment 4 or 5 was independent factor predicting hard to extreme adhesions at the hepatic hilum regardless of the use of anti-adhesion materials. Conclusions: The new difficulty scoring system for the lysis of adhesion at ReHx showed good interobserver agreement and reproducibility of the results. Given the strong correlation with postoperative morbidity rate, the present score could be used for evaluating the technical difficulties in ReHx and may offer a reliable measure for estimating the efficacy of anti-adhesion materials in future analysis.

Repeat hepatectomy for patients with early and late recurrence of hepatocellular carcinoma: A multicenter propensity score matching analysis

BackgroundRepeat hepatectomy is a feasible treatment modality for intrahepatic recurrence after hepatectomy of hepatocellular carcinoma, yet the survival benefit remains ill-defined. The objective of the current study was to define long-term, oncologic outcomes after repeat hepatectomy among patients with early and late recurrence. MethodsPatients undergoing curative-intent repeat hepatectomy for recurrent hepatocellular carcinoma were identified using a multi-intuitional database. Early and late recurrence was defined by setting 1 year after initial hepatectomy as the cutoff value. Patient clinical characteristics, overall survival, and disease-free survival were compared among patients with early and late recurrence before and after propensity score matching. ResultsAmong all the patients, 81 had early recurrence and 129 had late recurrence from which 74 matched pairs were included in the propensity score matching analytic cohort. Before propensity score matching, 5-year overall survival and disease-free survival after resection of an early recurrence were 41.7% and 17.9%, respectively, which were worse compared with patients who had resection of a late recurrence (57.0% and 39.4%, both P < .01). After propensity score matching, 5-year overall survival and disease-free survival among patients with early recurrence were worse compared with patients with late recurrence (41.0% and 19.2% vs 64.3% and 43.2%, both P < .01). After adjustment for other confounding factors on multivariable Cox-regression analysis, early recurrence remained independently associated with decreased overall survival and disease-free survival (hazard ratio 2.22, 95% confidence interval 1.35–3.34, P = .001; hazard ratio 1.86, 95% confidence 1.26–2.74, P = .002). ConclusionRepeat hepatectomy for early recurrence was associated with worse overall survival and disease-free survival compared with late recurrence. These data may help inform patients and selection of patients being considered for repeat hepatectomy of recurrent hepatocellular carcinoma.

Repeat hepatectomy in patients with colorectal liver metastases

Aim. To improve the results of treatment recurrent colorectal liver metastases after liver resection with its isolated lesion. Materials and methods . The results of repeated surgical treatment of recurrent colorectal liver metastases in 78 patients were analyzed. Postoperative complications frequency and blood loss was similar during primary and repeated resections. The five-year survival rate after repeated liver resection with reccurens of colorectal cancer liver metastases was 49 ± 9%. Results. Multivariate analysis revealed 3 predictors of the favorable prognosis of liver resection: removal of all extrahepatic metastases at the repeated resection, radicality of the repeated procedure, chemotherapy after repeated resection. Conclusion. Long-term results of the repeated surgical treatment of recurrent colorectal liver metastases recognize the feasibility of repeated liver resection in a separate category of patients. The treatment strategy for colorectal cancer liver metastases requires a combined multidisciplinary approach. This approach may include methods of local, regional or systemic antitumor effects in addition to resection, if indications exist.

Repeat hepatectomy for patients with recurrent neuroendocrine liver metastasis: Comparison with first hepatectomy

BackgroundThe value of repeat hepatectomy for intrahepatic recurrence after curative resection of neuroendocrine liver metastasis (NELM) remains unclear. The aim of this retrospective cohort study was to determine the significance of repeat hepatectomy for recurrent NELM. MethodsPatients who underwent hepatectomy for NELM between 1994 and 2016 were identified. The indications for a first hepatectomy were adequate liver remnant volume and no extrahepatic metastasis. The diagnosis of recurrent NELM was based on radiographic examinations. The indications for a repeat hepatectomy were the same as those for the first hepatectomy. Clinicopathologic factors, short-term survival, and long-term survival were investigated using clinical records. ResultsForty-four patients enrolled in this study. Thirty-three patients among them underwent a curative hepatectomy, and 28 of them developed recurrence. Of them, 16 patients underwent a repeat hepatectomy. The overall survival of the repeat hepatectomy cohort (n = 16) was significantly better than that of the no repeat hepatectomy cohort (n = 12) (P < .001). The progression free survival after the first hepatectomy (n = 44) and that after repeat hepatectomy (n = 16) were similar (P = .546). No significant difference was seen between the frequency of major complications (Clavien-Dindo score ≥ 3a) after the first and repeat hepatectomy (P = .279). No repeat hepatectomy (hazard ratio [HR] 5.0, P = .036) was identified as an independent predictive factor of a poor outcome among the recurrent cohort, along with the presence of multiple nodules (HR 26.2, P = .008) and a CA19-9 level ≥40 U/mL (HR 11.2, P = .012). ConclusionsA repeat hepatectomy is feasible in selected patients with recurrent NELM.

Outcome of repeat hepatectomy in patients with hepatocellular carcinoma aged 75 years and older

We sought to evaluate the influence of age on the outcome of repeat hepatectomies in patients > or = 75 years with recurrent hepatocellular carcinoma (HCC). We studied 121 curative repeat hepatectomies retrospectively. Among the 121 patients, 100, 20, and 1 received second, third, and fourth hepatectomies, respectively. The short-term surgical results of a younger group (<75 years; n = 88) and those of an elderly group (> or = 75 years; n = 33) were compared. The long-term prognosis of the patients who underwent second hepatectomies was also compared between a younger group (<75 years; n = 77) and an elderly group (> or = 75 years; n = 23). The patients in the elderly group displayed more comorbid conditions pre-operatively, including hypertension and cardiovascular diseases, than the younger group (P < .05); however, there was no significant difference in the incidence of postoperative complications or the duration of postoperative hospital stay. The long-term prognosis in the elderly group was almost identical to that in the younger group. The 3-year overall survival rates for the younger group and the elderly group were 83 vs 73% (P = .51). Disease-free, 3-year survival rates for the younger group and the elderly group were 35% vs 38% (P = .88). Our findings suggest that advanced age by itself does not have an adverse effect on operative outcomes, including postoperative complications and long-term prognosis. Repeat hepatectomy may, therefore, be justified for recurrent HCC in selected elderly patients.

Selection criteria for repeat hepatectomy in patients with recurrent hepatocelluler carcinoma: Masami Minagawa, Masatoshi Makuuchi, Tadatoshi Takayama, Norihiro Kokudo, University of Tokyo, Tokyo Japan

Selection criteria for repeat hepatectomy in patients with recurrent hepatocelluler carcinoma: Masami Minagawa, Masatoshi Makuuchi, Tadatoshi Takayama, Norihiro Kokudo, University of Tokyo, Tokyo Japan

Selection Criteria for Repeat Hepatectomy in Patients With Recurrent Hepatocellular Carcinoma

The purpose of this study was to evaluate prognostic factors in patients with recurrence after curative resection of hepatocellular carcinoma (HCC) and to identify selection criteria for repeat resection. Recent studies have demonstrated that repeat hepatectomy is effective for treating intrahepatic recurrent HCC in selected patients. However, the prognostic factors in these patients have not been fully evaluated. From October 1994 to December 2000, 334 patients underwent primary resection for HCC, and 67 received a 2nd hepatectomy for recurrent HCC. The survival results in these 67 patients were analyzed, and prognostic factors were determined using 38 clinicopathological variables. The prognosis and operative risk in 11 and 6 patients who received a 3rd and 4th resection were also evaluated. The overall 1-, 3-, and 5-year survival rates of the 334 patients after primary hepatectomy were 94%, 75%, and 56%, while those of the 67 patients after a 2nd resection were 93%, 70%, and 56%, respectively. There was no difference in survival (P = 0.64). All of the patients who underwent a 3rd or 4th are currently alive at a median follow-up of 2.5 and 1.4 years, respectively. The operative time and blood loss in the 2nd resection in patients who underwent a major primary resection were not different from those in patients who underwent minor hepatectomy at the 1st resection, and there were also no differences in these variables among the 2nd, 3rd, and 4th resections. In a multivariate analysis, absence of portal invasion at the 2nd resection (P = 0.01), single HCC at primary hepatectomy (P = 0.01), and a disease-free interval of 1 year or more after primary hepatectomy (P = 0.02) were independent prognostic factors after the 2nd resection. Twenty-nine patients with all 3 of these factors showed 3- and 5-year survival rates of 100% and 86%, respectively, after the 2nd resection. Repeat hepatic resection is the treatment of choice for patients who have previously undergone resection of a single HCC at the primary resection and in whom recurrence developed after a disease-free interval of 1 year or more and the recurrent tumor had no portal invasion.

Prognostic factors for poor survival after repeat hepatectomy in patients with colorectal liver metastases

Background. The recurrence rate for colorectal liver metastases after repeat hepatic resection is high, and selection criteria for repeat hepatectomy are still controversial. Methods. Clinical data of patients undergoing repeat hepatectomy for metastatic colon cancer were reviewed retrospectively and compared with those of initial hepatectomy and other treatments to determine criteria for repeat hepatectomy and to confirm its efficacy. Results. For 22 patients who underwent repeat hepatectomy, no mortality and an 18% morbidity rate were observed. The 3-year survival rate after repeat hepatectomy was 49%. The only poor prognostic factor after repeat hepatectomy was a serum carcinoembryonic antigen level greater than 50 ng/mL before initial hepatectomy. The prognosis for patients who underwent repeat hepatectomy and had shown high carcinoembryonic antigen levels before initial hepatectomy was approximately equal to that for the patients who received systemic chemotherapy or hepatic arterial infusion for unresectable tumors in the remnant liver. Conclusion. Repeat hepatectomy for colorectal liver metastases can be performed safely and appears to be as effective as initial hepatectomy. However, for patients with a carcinoembryonic antigen level greater than 50 ng/mL before the initial hepatectomy, repeat hepatic resection alone may not be as effective, and a new strategy is needed. (Surgery 2003;133:627-34.)

Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma

Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma