scholarly journals Hepatocellular Carcinoma: Current Management and Future Development—Improved Outcomes with Surgical Resection

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Yoji Kishi ◽  
Kiyoshi Hasegawa ◽  
Yasuhiko Sugawara ◽  
Norihiro Kokudo
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Resection ◽  
Laparoscopic Hepatectomy ◽  
High Recurrence Rate ◽  
Optimal Timing ◽  
Remnant Liver ◽  
Long Term Outcomes ◽  
Multiple Tumor ◽  
First Choice

Currently, surgical resection is the treatment strategy offering the best long-term outcomes in patients with hepatocellular carcinoma (HCC). Especially for advanced HCC, surgical resection is the only strategy that is potentially curative, and the indications for surgical resection have expanded concomitantly with the technical advances in hepatectomy. A major problem is the high recurrence rate even after curative resection, especially in the remnant liver. Although repeat hepatectomy may prolong survival, the suitability may be limited due to multiple tumor recurrence or background liver cirrhosis. Multimodality approaches combining other local ablation or systemic therapy may help improve the prognosis. On the other hand, minimally invasive, or laparoscopic, hepatectomy has become popular over the last decade. Although the short-term safety and feasibility has been established, the long-term outcomes have not yet been adequately evaluated. Liver transplantation for HCC is also a possible option. Given the current situation of donor shortage, however, other local treatments should be considered as the first choice as long as liver function is maintained. Non-transplant treatment as a bridge to transplantation also helps in decreasing the risk of tumor progression or death during the waiting period. The optimal timing for transplantation after HCC recurrence remains to be investigated.

scholarly journals Long-term Outcomes after Laparoscopic Hepatectomy for Hepatocellular Carcinoma

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S146
Author(s):  
D. Kilburn ◽  
D. Cavallucci ◽  
U. Leung ◽  
M. Siriwardhane ◽  
R. Bryant ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Laparoscopic Hepatectomy ◽  
Long Term Outcomes

Comparison of short- and long-term outcomes of patients with hepatocellular carcinoma undergoing surgical resection, local ablation, angiological treatment or palliation: Single center results over 35 years

2019 ◽  
Author(s):  
Valtteri Kairaluoma ◽  
Mira Karjalainen ◽  
Juha Saarnio ◽  
Jarmo Niemelä ◽  
Heikki Huhta ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Resection ◽  
Survival Rates ◽  
Confounding Factors ◽  
Single Center ◽  
Long Term Outcomes ◽  
Local Ablation ◽  
Short And Long Term ◽  
Overall Survival Rates

Abstract Background Hepatocellular carcinoma (HCC) is one leading cause of cancer mortality often presenting at inoperable stage. The aim of this study was to examine and compare surgically resected, locally ablated, angiologically treated and palliatively treated HCC patients’ short- and long-term outcomes in a single center over 35 year period. Methods All HCC diagnosed in Oulu University Hospital between 1983-2018 were identified from hospital records (n=273). Patients underwent hepatic resection (n=49), local ablation (RF, laser ablation or PEI; n=25), angiological treatments (TACE, TAE and SIRT; n=48) or palliative treatment (chemotherapy, best supportive care; n=151). Primary outcomes of the study were postoperative complications within 30 days after the operation, and short- (30- and 90-day) and long-term (1, 3 and 5-year) survival. Results were adjusted with sex, age, comorbidities, cirrhosis, Child-Pugh index points, ASA status, year of operation and stage. Results Surgically resected patients were younger than patients in other groups. Recurrence and local recidives occurred more often in local ablation group and in angiological treatment group (p<0.001). Surgical resection rate was 17.9%. Overall complication rates in surgical resection, local ablation and angiological group were 71.5%, 32.0% and 58.3%, (p<0.001). Major complications in respective groups occurred in 28.6%, 8.0% and 27.1%. Overall survival rates in surgical resection group were at 30 and 90 days, 1-, 3 and 5-years 95.9%, 95.9%, 85.1%, 59.0% and 51.2%. In local ablation group, respective overall survival rates were 100.0%, 100.0%, 86.1%, 43.1% and 18.8%, and in angiological group 95.8%, 93.6%, 56.1%, 26.3% and 6.6%. In cox regression model adjusted for confounding factors, local ablation and angiological treatment were significant risk factors for mortality. Prognosis was poor in palliatively treated patients. Conclusions Based on our study on Northern Finland population, the surgical resection of HCC seems to be the most effective treatment considering long-term survival and tumor recurrence after adjustment for confounding factors.

scholarly journals Shorter survival after liver pedicle clamping in patients undergoing liver resection for hepatocellular carcinoma revealed by a systematic review and meta-analysis

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
C -H Wassmer ◽  
B Moeckli ◽  
T Berney ◽  
C Toso ◽  
L Orci
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Liver Resection ◽  
Tumor Recurrence ◽  
Ischemia Reperfusion ◽  
Meta Analysis ◽  
Remnant Liver ◽  
Long Term Outcomes ◽  
The Impact

Abstract Objective Liver pedicle clamping minimizes surgical bleeding during hepatectomy. However, by inducing ischemia-reperfusion injury to the remnant liver, pedicle clamping may be associated with tumor recurrence in the regenerating liver. Hepatocellular carcinoma (HCC) having a high rate of recurrence, evidences demonstrating an eventual association with pedicle clamping is strongly needed. Methods We did a systematic review of the literature until April 2020, looking at studies reporting the impact of liver pedicle clamping on long-term outcomes in patients undergoing liver resection for HCC. Primary and secondary outcomes were overall survival (OS) and disease-free survival, respectively. Results Results were obtained by random-effect meta-analysis and expressed as standardized mean difference (SMD). Eleven studies were included, accounting for 8087 patients. Results of seven studies were pooled in a meta-analysis. Findings indicated that, as compared to control patients who did not receive liver pedicle clamping, those who did had a significantly shorter OS (SMD = -0.172, 95%CI: -0.298 to -0.047, p = 0.007, I2=76.8%) and higher tumor recurrence rates (odds ratio 1.36 1.01 to 1.83. p = 0.044, I2=50.7%). Conclusion This meta-analysis suggests that liver pedicle clamping may have a deleterious impact on long-term outcomes. An individual patient-data meta-analysis of randomized trials evaluating liver pedicle clamping is urgently needed.

scholarly journals Shorter Survival after Liver Pedicle Clamping in Patients Undergoing Liver Resection for Hepatocellular Carcinoma Revealed by a Systematic Review and Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 637
Author(s):  
Charles-Henri Wassmer ◽  
Beat Moeckli ◽  
Thierry Berney ◽  
Christian Toso ◽  
Lorenzo A. Orci
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Liver Resection ◽  
Tumor Recurrence ◽  
Ischemia Reperfusion ◽  
Meta Analysis ◽  
Remnant Liver ◽  
Long Term Outcomes ◽  
The Impact

Liver pedicle clamping minimizes surgical bleeding during hepatectomy. However, by inducing ischemia-reperfusion injury to the remnant liver, pedicle clamping may be associated with tumor recurrence in the regenerating liver. Hepatocellular carcinoma (HCC) having a high rate of recurrence, evidences demonstrating an eventual association with pedicle clamping is strongly needed. We did a systematic review of the literature until April 2020, looking at studies reporting the impact of liver pedicle clamping on long-term outcomes in patients undergoing liver resection for HCC. Primary and secondary outcomes were overall survival (OS) and disease-free survival, respectively. Results were obtained by random-effect meta-analysis and expressed as standardized mean difference (SMD). Eleven studies were included, accounting for 8087 patients. Results of seven studies were pooled in a meta-analysis. Findings indicated that, as compared to control patients who did not receive liver pedicle clamping, those who did had a significantly shorter OS (SMD = −0.172, 95%CI: −0.298 to −0.047, p = 0.007, I2 = 76.8%) and higher tumor recurrence rates (odds ratio 1.36 1.01 to 1.83. p = 0.044, I2 = 50.7%). This meta-analysis suggests that liver pedicle clamping may have a deleterious impact on long-term outcomes. An individual patient-data meta-analysis of randomized trials evaluating liver pedicle clamping is urgently needed.

Chronological improvement in long-term outcomes of surgical resection for patients with hepatocellular carcinoma: two large-volume center studies

2020 ◽  
Vol 73 ◽  
pp. S397-S398
Author(s):  
Yun Bin Lee ◽  
Jeonghoon Lee ◽  
Hyo Young Lee ◽  
Cheol-Hyung Lee ◽  
Minseok Albert Kim ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Resection ◽  
Large Volume ◽  
Long Term Outcomes

scholarly journals Impact of conversion on the perioperative and long-term outcomes during laparoscopic hepatectomy for patient with hepatocellular carcinoma

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S361
Author(s):  
Wanguang Zhang ◽  
Youliang Pei ◽  
Zhanguo Zhang ◽  
Lei Zhang ◽  
Hongping Luo ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Laparoscopic Hepatectomy ◽  
Long Term Outcomes
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