Anatomical <i>vs</i> nonanatomical liver resection for solitary hepatocellular carcinoma: A systematic review and meta-analysis

Liu, Hu; Hu, Fayun; Li, Hui; Lan, Tian; Wu, Hong

doi:10.4251/wjgo.v13.i11.1833

Cited by 13 publications

(8 citation statements)

References 49 publications

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“…Thus, the AR surgical technique is more effective than NAR. However, compared to NAR, AR is associated with the adverse features of major liver resection, longer operating time, increased blood loss, and wider surgical margins, and is generally regarded as a more technically demanding operation [ 17 ]. Laparoscopic AR is even more challenging, especially for lesions located close to the main hepatic vein, portal vein, or inferior vena cava [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Cheng

Wang²,

Liu³

et al. 2022

PLoS ONE

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Background Laparoscopic hepatectomy (LH) has achieved rapid progress over the last decade. However, it is still challenging to apply laparoscopy to lesions located in segments I, VII, VIII, and IVa and the hepatic hilar region due to difficulty operating around complex anatomical structures. In this study, we applied three-dimensional printing (3DP) and indocyanine green (ICG) fluorescence imaging technology to complex laparoscopic hepatectomy (CLH) to explore the effects and value of the modified procedure. Materials and methods From January 2019 to January 2021, 54 patients with complex hepatobiliary diseases underwent LH at our center. Clinical data were collected from these patients and retrospectively analyzed. Results A total of 30 patients underwent CLH using the conventional approach, whereas 24 cases received CLH with 3DP technology and ICG fluorescent navigation. Preoperative data were compared between the two groups. In the 3DP group, we modified the surgical strategy of four patients (4/24, 16.7%) due to real-time intraoperative navigation with 3DP and ICG fluorescent imaging technology. We did not modify the surgical strategy for any patient in the non-3DP group (P = 0.02). There were no significant differences between the non-3DP and 3DP groups regarding operating time (297.7±104.1 min vs. 328.8±110.9 min, P = 0.15), estimated blood loss (400±263.8 ml vs. 345.8±356.1 ml, P = 0.52), rate of conversion to laparotomy (3/30 vs. 2/24, P = 0.79), or pathological outcomes including the incidence of microscopical R0 margins (28/30 vs. 24/24, P = 0.57). Additionally, there were no significant differences in postoperative complications or recovery conditions between the two groups. No instances of 30- or 90-day mortality were observed. Conclusion The optimal surgical strategy for CLH can be chosen with the help of 3DP technology and ICG fluorescent navigation. This modified procedure is both safe and effective, but without improvement of intraoperative and short-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Cheng

Wang²,

Liu³

et al. 2022

PLoS ONE

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“…In addition to margin status alone, it has also been proposed that anatomic resection as compared to non-anatomic resection, may result in improved outcomes by removal of tumor-bearing portal territories. A systematic review and meta-analysis of 9,444 patients suggested improved 5-year disease-free and OS, although no included studies were prospective ( 51 ). However, liver resections are limited both by the size and function of the liver remnant, as well as the association of the tumor with critical structures which may preclude the clearing of all microscopic disease, making increasing the margin size in many patients impossible.…”

Section: Determination Of Minimal Residual Disease (Mrd)and Post-oper...mentioning

confidence: 99%

Existing and emerging biomarkers in hepatocellular carcinoma: relevance in staging, determination of minimal residual disease, and monitoring treatment response: a narrative review

Dominguez¹,

Wong²,

Melstrom³

2024

Hepatobiliary Surg Nutr

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Background and Objective With the development of novel active systemic therapies, the landscape of hepatocellular carcinoma (HCC) management is rapidly changing. However, HCC lacks sensitive and specific biomarkers to predict prognosis, monitor for minimal residual disease after locoregional therapy, and predict treatment response. In this review, we aim to summarize the best supporting evidence for refining existing, and development of novel biomarkers for staging, prognosis, determination of minimal residual disease and monitoring treatment response in HCC, focusing on those with evidence in clinical trials. Methods PubMed and Embase databases were searched using the keywords; hepatocellular carcinoma, biomarker, minimal residual disease, surveillance, prognosis, staging, alpha-fetoprotein (AFP), liquid biopsy, treatment response, adjuvant, immunotherapy. Relevant clinical studies were included. Key Content and Findings AFP remains the major workhorse as the most widely used biomarker in HCC, however, its lack of wide applicability due to the high proportion of patients with HCC who are AFP negative, limits its value throughout all stages of HCC management. Significant work has been done to combine AFP with other clinical and serologic factors to increase its accuracy and utility as a biomarkers. However, it is likely that other more novel biomarkers such as those obtained through liquid biopsy will provide the prognostic power necessary for applications such as detecting recurrence and predicting treatment response. Liquid biopsy provides not only a wealth of potential biomarkers including circulating tumor cells and cell-free RNA/DNA, but also the ability to examine the mutational characteristics of the tumor with next generation sequencing. While early evidence supports the potential impact of many new biomarkers, validation in large clinical trials is lacking. Conclusions This review highlights the paucity of sensitive and specific, widely applicable biomarkers, throughout all phases of management of HCC and summarizes evidence on biomarkers currently in use, as well as those in development and validation. Inclusion of biomarker analysis through clinical trials in HCC is critical to development of optimal therapeutic regimens, and improve patient outcomes.

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“…The problem of the resection margin has also been debated, since according to Makuuchi’s theory the tumor-free margin doesn’t merely depend on the distance from the tumor ( 42 , 43 ). A study involving 288 patients from Poon et al showed that the width of the resection margin did not influence the postoperative recurrence rates.…”

Section: Predictive Factors For Hcc Recurrencementioning

confidence: 99%

Management of hepatocellular carcinoma recurrence after liver surgery and thermal ablations: state of the art and future perspectives

Herrero,

Toubert,

Bedoya

et al. 2024

Hepatobiliary Surg Nutr

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Despite the improvements in surgical and medical therapy for hepatocellular carcinoma (HCC), recurrence still represents a major issue. Up to 70% of patients can experience HCC recurrence after liver resection (LR), as well as 20% of them even after liver transplantation (LT). The patterns of recurrence are different according to both the time and the location. Similarly, the risk factors and the management can change not only according to these patterns, but also according to the underlying liver condition and to the first treatment performed. Deep knowledge of such correlation is fundamental, since prevention and effective management of recurrence are undoubtedly the most important strategies to improve the outcomes of HCC treatment. Without adjuvant therapy, maintaining very close monitoring during the first 2 years in order to diagnose curable recurrence and continue this monitoring beyond 5 years because late recurrences exist, remains our only possibility today. Surgery represents the cornerstone treatment for HCC, including both LT and LR. However, new interesting therapeutic opportunities are coming from immunotherapy that has shown encouraging results also in the adjuvant setting. In such a complex and evolutionary scenario, the aim of this review is to summarize current strategies for the management of HCC recurrence, focusing on the different possible scenarios, as well as on future perspectives

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Anatomical vs nonanatomical liver resection for solitary hepatocellular carcinoma: A systematic review and meta-analysis

Cited by 13 publications

References 49 publications

Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Existing and emerging biomarkers in hepatocellular carcinoma: relevance in staging, determination of minimal residual disease, and monitoring treatment response: a narrative review

Management of hepatocellular carcinoma recurrence after liver surgery and thermal ablations: state of the art and future perspectives

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