Surgical Resection For Hepatocellular Carcinoma Research Articles

Prognostic factors in surgical resection for hepatocellular carcinoma.

Although a variety of new treatment modalities for hepatocellular carcinoma (HCC) have been explored in the past few years, the fact remains that surgical resection provides the only chance for long-term survival in this aggressive disease. Five-year survival rates after curative surgery average 18-36%. In general, a resectable tumor must be (1) confined to the liver (absence of vascular invasion or distant metastases) and (2) entirely encompassed by local excision with an adequate margin. In order to be a candidate for resection, the patient must also have adequate liver reserve. Only 10-15% of patients with primary liver cancer meet these requirements. Unfortunately, the majority of these patients develop recurrence and do not benefit from further resection.

Surgical resection of hepatocellular carcinoma in cirrhotic patients: Prognostic value of preoperative portal pressure

BACKGROUND & AIMS: Although resection of hepatocellular carcinoma complicating cirrhosis is restricted to patients with preserved liver function, postoperative hepatic decompensation develops in some patients. The aim of this study was to determine the value of increased portal pressure in the development of postoperative hepatic decompensation. METHODS: Twenty-nine cirrhotic patients with Child- Pugh's class A disease and hepatocellular carcinoma (all except one < 5 cm) scheduled to undergo resection were evaluated by conventional criteria and by a systemic and hepatic hemodynamic study. Predictors of decompensation were assessed among a series of 44 clinical, analytical, tumoral, and hemodynamic parameters. RESULTS: Eleven patients had unresolved decompensation 3 months after surgery. Bilirubin and blood ureic nitrogen levels, platelet count, wedged hepatic venous pressure, hepatic venous pressure gradient, and indocyanine green intrinsic clearance were significantly associated with unresolved decompensation, but only hepatic venous pressure gradient was significant, in the multivariate analysis (P = 0.0001; odds ratio, 1.90; 95% confidence interval, 1.12-3.22). The preoperative gradient of patients with unresolved decompensation was higher than that of patients without it (13.9 +/- 2.4 and 7.4 +/- 3.5 mm Hg, respectively; P < 0.001). CONCLUSIONS: Cirrhotics with increased portal pressure are at high risk of hepatic decompensation after resection of hepatocellular carcinoma. Surgical resection should therefore be restricted to patients without portal hypertension. (Gastroenterology 1996 Oct;111(4):1018-22)

Ultrasound-guided cutting biopsy for the diagnosis of hepatocellular carcinoma — a study based on 420 patients

Background/Aims: To evaluate ultrasound-guided cutting biopsy for hepatocellular carcinoma, we report findings from 10 years of experience. Methods: We performed 455 ultrasound-guided cutting biopsies of hepatic tumors in 420 patients with hepatocellular carcinoma from 1981 to 1990. Results: Liver tissues were adequately sampled for a histological diagnosis of hepatocellular carcinoma in the initial biopsy in 391 sessions. The remaining 64 were proved to have hepatocellular carcinoma after subsequent studies. Ultrasound-guided biopsy changed the initial diagnosis in 9 of the 420 patients: three had been diagnosed with liver abscess, and six with metastatic liver tumors. Complications of the biopsy were rare: the tumor had spread to the chest wall in nine, and internal bleeding was noted in five patients. There was no mortality and no other sequelae. Conclusions: Ultrasound-guided biopsy of hepatic tumors is important in the diagnosis of liver cancer, but this technique should be applied only when the image diagnosis and results of fine needle biopsy are equivocal to minimize possible complications. For patients with small HCCs, who are candidates for surgical resection of hepatocellular carcinoma or liver transplantation, it should not be considered as a first-step invasive procedure.

Surgical Resection of Hepatocellular Carcinoma.

BACKGROUND: Surgical management of hepatocellular carcinoma is challenging. Advances in patient selection and operative techniques are taking place in various parts of the world. METHODS: The literature on diagnosis, evaluation, and surgical treatment of hepatocellular carcinoma is reviewed and combined with the extensive clinical experience of the authors. RESULTS: While alpha-fetoprotein levels often are elevated in patients with large hepatocellular tumors, a combination of hepatic arteriography and Lipiodol computed tomography is the most sensitive imaging approach. An indocyanine green retention of more than 14% at 15 minutes predicts a poor outcome from surgery. Intraoperative ultrasound and ultrasonic dissector assist surgery. One-, three-, and five-year survival rates of 68%, 44%, and 35%, respectively, have been reported. CONCLUSIONS: Methods to diagnose and assess the suitability of patients with hepatocellular carcinoma for surgical resection are now available, and operative and postoperative care has improved. Surgery remains the "gold standard" to which other treatments can be compared.

Surgical resection for small hepatocellular carcinoma

Surgical resection for hepatocellular carcinoma (HCC) can be curative in selected patients, particularly in those with a solitary small HCC (s-sHCC; 2 cm or less in diameter). However, even these patients often have a risk of tumor recurrence or death from underlying liver dysfunction. Therefore it is important to determine which clinicopathologic features are related to the long-term prognosis after resection of s-sHCC. Fifty patients with s-sHCC underwent partial hepatectomy at our department between 1977 and 1992. Six (12%) died of liver failure in hospital after operation. Eight clinicopathologic features were examined in the remaining 44 patients with regard to their long-term prognosis by use of univariate and multivariate analyses. The 1-, 3-, and 5-year survival rates were 90%, 75%, and 53%, respectively. The corresponding disease-free survival rates were 80%, 53%, and 30%, respectively. None of the following parameters was significantly related to survival rate or disease-free survival rate: presence of vascular invasion or capsular formation, the distance of free surgical margin (1 cm or more or not), serum alpha-fetoprotein level, positive hepatitis B surface antigen, and preoperative transarterial embolization. Complicated liver function was the only significant factor related to survival rate and disease-free survival rate. A good hepatic reserve is an important factor in treating patients with s-sHCC by surgical resection, even for a long-term prognosis. Liver transplantation should be considered for patients with severe cirrhosis and s-sHCC, even though a curative resection might be possible.

Surgical resection of hepatocellular carcinoma (HCC) in cirrhotics, prognostic value of preoperative portal pressure: [formula omitted]. Liver Unit, Hospital Clinic i Provincial, University of Barcelona

Surgical resection of hepatocellular carcinoma (HCC) in cirrhotics, prognostic value of preoperative portal pressure: [formula omitted]. Liver Unit, Hospital Clinic i Provincial, University of Barcelona

Chemo-occlusion for the treatment of liver cancer. A new technique using degradable starch microspheres.

The use of particulate embolic agents combined with regional chemotherapy in the treatment of hepatocellular carcinoma and metastatic liver cancer has been widely investigated over the past decade. The rationale for the use of such agents is to provide vascular blockade, resulting in a reduced or halted blood flow. This increases the in situ time, tumour exposure and, thus, efficacy of any coadministered cytotoxic drug. Of all the embolic agents and techniques available, degradable starch microspheres (DSMs) are the agents that have been evaluated most extensively. DSMs are non-toxic, are readily degradable and provide temporary vascular occlusion. Phase II and III clinical trials have demonstrated the efficacy of DSM when coadministered with chemotherapeutic drugs (chemo-occlusion), as measured by tumour response. Indeed, compared with drug therapy alone, a significantly greater tumour response is associated with chemo-occlusion, for patients with either hepatocellular carcinoma or metastatic liver cancer. The use of combination or multi-modular therapies have, in recent years, been investigated. The therapeutic benefits associated with chemo-occlusion would suggest that this technique might have a potential application as an adjuvant, or neoadjuvant therapy, for example, in reducing tumour recurrence after surgical resection in hepatocellular carcinoma, or downstaging a tumour prior to surgical resection, respectively. Furthermore, comprehensive management of patients with liver metastases and potential extrahepatic involvement may well be achieved by a combination of DSM chemo-occlusion and systemic chemotherapy. Large, randomised trials are, however, required to access more fully the clinical benefits associated with chemo-occlusion, such as, quality of life, time to tumour progression and survival. Regionally occlusive techniques administered with cytotoxic agents have also shown potential in the treatment of alternative cancers, for example, breast and pancreatic carcinomas. However, these therapies require further evaluation.

Surgical treatment for hepatocellular carcinoma

1979年以来, 396例の原発性肝細胞癌入院症例を経験し, 切除例は153例39%である. 切除例の中, 肝硬変症例は82%を占める. 耐術例での5年累積生存率は49%であり, 5年累積無再発生存率は21%である. 肝癌切除後の残肝再発は, 肝硬変症例における多中心性発生例も含め高率であり, 長期生存を得るためには再発巣に対しても再切除をはじめとした積極的な治療が必要である. 再発に関与する因子としてもっとも重要なものは, 肝内転移の有無 (im因子) や治癒切除が行われたか否かである. また, 細胞核DNA PLOIDY PATTERNも予後に影響する重要な因子の一つである. 本論文では, 教室の肝細胞癌に対する治療方針とその適応・成績について自験例を中心に概説した.

Detection of Hepatitis C Virus RNA in Sera and Liver Tissues of Non‐A, Non‐B Hepatitis Patients Using the Polymerase Chain Reaction

Sera obtained from patients with non‐A, non‐B hepatitis were examined for the presence of hepatitis C virus (HCV) genome by using the reverse transcription‐polymerase chain reaction assay, as well as for antibody to HCV (anti‐HCV) by using an enzyme‐linked immunosorbent assay (ELISA). We also examined the presence of HCV RNA in liver tissue obtained by surgical resection of hepatocellular carcinoma. Among 33 patients, HCV RNA was detectable in 21 (64%), and the antibody was also positive in 21 (64%). Eighteen (55%) patients were positive for both assays. The two assays gave inconsistent results in 3 patients who were positive for HCV RNA but negative for anti‐HCV, and in 3 other patients who were negative for HCV RNA and positive for anti‐HCV. HCV RNA was also detected in 6 out of 10 non‐cancerous liver tissue specimens and in 3 out of 7 tumor tissue specimens. Using the polymerase chain reaction, the HCV genome was detected directly in many specimens obtained from patients with non‐A, non‐B hepatitis, suggesting the presence of replicating virus in patients positive for anti‐HCV. In addition, the differing results of the two assay systems suggest that the application of both is important for evaluation of the status of HCV infection.

Elevation of c-myc transcript level in human liver during surgical resection of hepatocellular carcinoma: Possible cause for underestimation of c-myc gene activation in the tumor

It has been a matter of controversy as to whether c- myc gene expression is activated in human hepatocellular carcinoma (HCC). We observed that the c- myc mRNA level in HCC was similar to that of the adjacent non-cancerous portion, as determined in freshly obtained specimens after a partial liver resection. However, the c- myc transcript was at a low level in non-cancerous tissue which was biopsied prior to surgery, whereas it was still at a high level in HCC obtained without performing hepatectomy. These results suggest that the high transcript level observed in the non-cancerous tissue from the excised liver relates to liver resection itself, and that the c- myc gene expression is enhanced in the HCC.

Clearance of hepatitis B surface antigen (HBsAg) after surgical resection of hepatocellular carcinoma

The serum HBsAg in 4 chronic HBsAg carrier patients with hepatocellular carcinoma (HCC) cleared within 4-38 months after surgical resection of their hepatic tumors. Two patients developed anti-HBs. During the follow-up period from 21 to 28 months after HBsAg clearance, none of the patients regained positive serum HBsAg. Two patients who had had tissue HBsAg present, exclusively in the tumor, showed quick HBsAg clearance after resection. The other 2 patients had a delayed HBsAg clearance. One had tissue HBsAg in both the tumor and nontumoral liver. Only 1 patient had tissue HBsAg in the liver, but not in the tumor. During the same period of observation of 323 chronic HBsAg carriers, who had a variety of histologically-verified chronic liver diseases and were followed for more than 6 months, only 1 cleared the antigen. The spontaneous HBsAg clearance in our HBsAg carriers (1/323) was significantly lower than that (4/64) of HBsAg-positive HCC patients with tumor resection, P less than 0.004. The mechanisms of HBsAg clearance in HCC patients after surgical resection of tumors are discussed.