Introduction: New markers associated with angiogenesis and tumor metastasis, such as circulating tumor cells (CTCs), are opening up new avenues in cancer management. The aim of this work is to determine the number of CTCs in patients included in waiting list for liver transplantation of hepatocellular carcinoma, to study its possible association with the clinical variables and to compare the pre and post-transplant levels (at one month, six months, one year and two years). Method: Peripheral blood of 36 patients with hepatocellular carcinoma in waiting list for liver transplant was obtained. The CTCs immunomagnetic isolation was performed with anti-EpCAM antibodies by IsoFluxÔ system. Results: The average concentration of CTCs before transplant was 11.50 CTCs/10mL (RI = 2.25e42). A statistically significant positive correlation was found between the pre-transplant levels of CTCs and the days on waiting list (Rho = 0,376 p = 0,024). Differences in the levels of CTCs were found between the patients with and without vascular invasion (U = 0,00 p = 0,020). The concentration of the pretransplant levels of CTCs were 9 (RI = 1e72), and 4 (RI = 1e11), 2 (RI = 0e15), 2 (RI = 0e4) and 3 (RI = 1e42) CTCs/10 mL, after one month, 6 months and one year and two years after transplantation, respectively. Statistically significant differences were found between the pre-transplant levels of CTCs and the same levels one month (Z = À2,313 p = 0,021) and one year after being transplanted (Z = À2,629 p = 0,09). Conclusions: CTCs could be an unfavourable prognostic factor associated to longer waiting times and to the presence of vascular invasion by tumor with an increased risk of relapse and post-transplant metastasis.
The invasion of the Inferior Cava Vein (IVC) and/or suprahepatic veins (SHV), represent a challenge for a R0 resection, achieved by vascular resections that often require reconstruction with grafts, both biological as prosthetics. The main objectives were the analysis of postoperative results (morbidity and mortality) at 90 days and overall and disease-free survival at 1 and 5 years. Methods: Retrospective study on a prospective database of approximately 1500 patients operated until September 2017. There was variability in the amount of resected parenchyma and about total or partial hilar occlusion, as well as in the SHV. Results: From the 13 patients who underwent liver resections with vascular reconstructions, 8 of them underwent IVC resection with replacement of a goretex graft, and 5 patients with invaded SHV underwent resections with placement of a 3 cm long LRV graft. The average age was 58 years (range 46-71). Hepatic volumetry was performed, getting an insufficient remnant liver volume in 7 cases, performing the ALPPS-TORNIQUETE technique. A hilar and IVC clamping test was performed and veno-venous bypass was never required. One patient died postoperatively (7.7%), and Clavien morbidity higher than IIIa was found in 5 cases. The actuarial survival at 1, 3 and 5 years was 87, 67 and 45% respectively. Conclusions: In cases of IVC or SHV invasion by a tumor, if there is a small remnant liver parenchyma, with prosthetic graft or autologous left renal vein replacement should be considered as a valid alternative when resections and complex vascular reconstructions are needed.
right, left and both lobes in 26, 3, 14 cases respectively. Tumor size was >5 cm in 24 (55.8%) cases and < 5 cm in 19 cases (44.2%). Treatment was done by DC BeadÔ 100-300mm or HepasphereÔ 150-200mm. Five patients (11.6%) received 1 TACE procedure, 11 patients (25.6%) received 2, 9 patients (20.9%) received 3, 8 patients (18.6%) received 4 and 10 patients (23.3%) received >4 TACE procedures respectively. For treatment result evaluation we used modified RECIST-relation between necrotic and still vascularized lesions. Conclusion: Chemoembolization with or without doxorubicin microspheres is a safe and effective procedure for advanced inoperable HCC. A single center experience showed that studies and routine protocol are required for analyzing the outcomes and efficacy of TACE.
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