Controversies and evidence of hepatic resection for hepatocellular carcinoma

Zhong, Jian; Torzilli, Guido; Xing, Hao; Li, Chao; Han, Jun; Liang, Lei; Zhang, Han; Yang, Tian; Li, Le Qun; Shen, Feng

doi:10.1016/j.bbacli.2016.10.001

Cited by 21 publications

(16 citation statements)

References 126 publications

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“…As far as the treatment strategy is concerned, different systems have also been developed, like BCLC (Barcelona Clinic Liver Cancer)-the only system endorsed by the European Association for the Study of the Liver and the American Association for the Study of Liver Disease (35), HKLC (Hong Kong Liver Cancer) and many others which try to indicate the therapy strategy for each combination of disease (cancer and cirrhosis) stage (35). The recent consensus meetings (based on a great body of evidence from studies in Western and Asian countries) stated that HCC involving a single tumor, regardless of its size should be resected, whenever technically possible (35) and, of course, when the volume and function of the remaining liver allows that.…”

Section: Discussion Discussionmentioning

confidence: 99%

The Salvage Liver Transplantation in the Treatment of Hepatocelullar Carcinoma

Grigorie¹,

Moisa²,

Popescu³

2017

JTMR

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Hepatocellular carcinoma (HCC) is the fifth most frequent cancer worldwide and in most cases it evolves on a cirrhotic liver, which requires a complex treatment strategy that includes different options. We present the case of a 62 years old patient, suffering from chronic HBV and HDV hepatitis, which was found, in 2011 with a 7 cm HCC located in the sixth segment of the liver and resected. Within less than a year, tumor relapse was detected (multiple nodules in the remaining sixth segment). Systemic chemotherapy (Sorafenib) started being administered and two TACE procedures were performed at one year and seven months difference. Despite that, the CT and MRI showed the evolution of the disease. The therapy was stopped and the patient was listed for liver transplantation and the procedure was performed. The thirteen months post transplantation assessment showed no sign of tumor relapse.

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Section: Discussion Discussionmentioning

confidence: 99%

The Salvage Liver Transplantation in the Treatment of Hepatocelullar Carcinoma

Grigorie¹,

Moisa²,

Popescu³

2017

JTMR

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“…The OS benefit of palliative treatment is not obvious. Moreover, we should also consider that these treatments are always associated with risk of adverse events and high costs [29] .…”

Section: Should Postoperative Hcc Patients Receive Adjuvant Treatmmentioning

confidence: 99%

Controversies of hepatectomy and adjuvant therapy for hepatocellular carcinoma: moving forward

Zhong¹,

Xiang²

2019

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Due to the prevelence of hepatitis B virus (HBV) and hepatitis C virus (HCV), occurrence of hepatocellular carcinoma (HCC) is increasing in many countries/regions, including China [1] . HBV and HCV infections, alcohol consumption, non-alcoholic steatohepatitis cirrhosis, or obesity pandemic are risk factors of HCC development. A recent survey study found about 70% patients with HCC are diagnosed as intermediate or advanced disease because of the lack of significant syndrome in their early stage [2] . Main treatments of HCC include hepatectomy, liver transplantation, ablation (radiofrequency, microwave, cryoablation), transarterial chemoembolization, radiotherapy, chemotherapy, target therapy, and so on. Among these treatments, only hepatectomy, liver transplantation, and ablation are curative treatments, with a 70% 5-year overall survival (OS) for early stage HCC. Hepatectomy is not recommended by Western official guidelines for intermediate and advanced stage HCC. However, Eastern official guidelines and many liver centres recommend hepatectomy for such patients who are with preserved liver function. Tumor recurrence, which occurs in 70% within 5 years after hepatectomy, is a major cause of death after hepatectomy [3] . This recurrence can be true recurrence relating to primary tumor (intrahepatic metastases), which occurs less than two years, or it can be due to the development of de novo tumors relating to liver disease (such as HBV/HCV and cirrhosis), which occurs at least two years later. Even so, none Western official guidelines recommend any effective adjuvant therapy to prevent HCC recurrence.Therefore, there are at least three controversies in the field of HCC treatment between literature evidence and official guidelines. Namely: 1. 2. 3. Should postoperative HCC patients receive adjuvant treatments?

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“…The available evidence, then, suggests that resection can be considered as initial therapy for HCC patients with type I or II (Vp0-Vp3) PVTT and preserved liver function. Surgeons should consider hepatic resection when it is feasible, though they should be prepared for the fact that the procedure is technically demanding [ 61 ].…”

Section: Monotherapies and Associated Prognosismentioning

confidence: 99%

Treatment of hepatocellular carcinoma with portal vein tumor thrombus: advances and challenges

et al. 2017

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Portal vein tumor thrombus is a frequent, challenging complication in hepatocellular carcinoma. Hepatocellular carcinoma patients with portal vein tumor thrombus may show worse liver function, less treatment tolerance and worse prognosis than patients without portal vein tumor thrombus, and they may be at higher risk of comorbidity related to portal hypertension. Western and some Asian guidelines stratify hepatocellular carcinoma with portal vein tumor thrombus together with metastatic hepatocellular carcinoma and therefore recommend only palliative treatment with sorafenib or other systemic agents. In recent years, more treatment options have become available for hepatocellular carcinoma patients with portal vein tumor thrombus, and an evidence-based approach to optimizing disease management and treatment has become more widespread. Nevertheless, consensus policies for managing hepatocellular carcinoma with portal vein tumor thrombus have not been established. This comprehensive literature review, drawing primarily on studies published after 2010, examines currently available management options for patients with hepatocellular carcinoma and portal vein tumor thrombus.

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Controversies and evidence of hepatic resection for hepatocellular carcinoma

Cited by 21 publications

References 126 publications

The Salvage Liver Transplantation in the Treatment of Hepatocelullar Carcinoma

The Salvage Liver Transplantation in the Treatment of Hepatocelullar Carcinoma

Controversies of hepatectomy and adjuvant therapy for hepatocellular carcinoma: moving forward

Treatment of hepatocellular carcinoma with portal vein tumor thrombus: advances and challenges

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