Differential significance of early surgical complications for acute and long-term recurrence-free survival following surgical resection of hepatocellular carcinoma: do comorbidities play a role?

Khandoga, Andrej; Drefs, Moritz; Schoenberg, Markus Bo; Schiergens, Tobias S.; Frenes, Katharina; Winkel, Mark op den; Trumm, C.; Angele, Martin K.; Guba, Markus; Werner, Jens; Rentsch, Markus

doi:10.1097/meg.0000000000000912

Cited by 13 publications

(6 citation statements)

References 38 publications

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“…Both, comorbidities and female sex-potentially by featuring less favorable clinical and molecular tumor characteristics-have already been observed to detrimentally influence oncological outcome in CRC and other cancers. 26,[34][35][36] With regard to timing, it is possible to perform the LAT before, synchronously or after the surgical resection. In contrast to many other countries where local ablative procedures are performed by surgeons intraoperatively and by ultrasound-guidance during liver resection, a sequential procedure is more common in Germany.…”

Section: Discussionmentioning

confidence: 99%

Chances, challenges and outcomes of patients with complex bilobar colorectal liver metastases approached by a combined multimodal therapy with liver resection and local ablative therapy

Drefs

Schoenberg

Schiergens

et al. 2021

Journal of Surgical Oncology

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Background and Objectives: In treatment of colorectal liver metastases (CRC-LM), liver surgery combined with systemic therapies and local ablation (LAT) allows improved survival. This study aims at the outcomes of patients with complex bilobar CRC-LM who were intended to undergo multimodal therapy with liver resection and LAT. Methods: Forty-three CRC-LM patients with recommendation for multimodal treament were extracted from 5878 tumor board decisions between 2014 and 2017. Outcome variables included patient survival, as well as completion of hepatic clearance. Prognostic factors were identified by correlation and a Cox proportional hazards model. Results: Out of 43 patients only 23 achieved complete clearance of CRC-LM. Oneand 3-year overall survival of patients with cleared liver disease was 100% and 91.7%, respectively, as compared to 83.8% and 12.1%. Incomplete hepatic clearance was the strongest independent risk factor for overall survival (hazards ratio [HR],

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Section: Discussionmentioning

confidence: 99%

Chances, challenges and outcomes of patients with complex bilobar colorectal liver metastases approached by a combined multimodal therapy with liver resection and local ablative therapy

Drefs

Schoenberg

Schiergens

et al. 2021

Journal of Surgical Oncology

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“…Previous reports have demonstrated the impact of comorbidities using the CCI on OS postoperatively in several malignant diseases [11–32, 39–74] (Table 8). In HCC patients, previous retrospective studies demonstrated the association between the CCI and prognosis after surgery [73, 74].…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of the Age‐Adjusted Charlson Comorbidity Index for Outcomes After Hepatic Resection of Hepatocellular Carcinoma

et al. 2020

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Background This study aimed to evaluate the impact of the age-adjusted Charlson comorbidity index (ACCI) on outcomes after hepatic resection for hepatocellular carcinoma (HCC). Methods We assessed 763 patients who underwent hepatic resection for HCC. The ACCI scores were categorized as follows: ACCI B 5, ACCI = 6, and ACCI C 7. Results A multivariate analysis showed that the odds ratios for postoperative complications in ACCI = 6 and ACCI C 7 groups, with reference to ACCI B 5 group, were 0.71 (p = 0.41) and 4.15 (p \ 0.001), respectively. The hazard ratios for overall survival of ACCI = 6 and ACCI C 7 groups, with reference to ACCI B 5 group, were 1.52 (p = 0.023) and 2.45 (p \ 0.001), respectively. The distribution of deaths due to HCC-related, liver-related, and other causes was 68.2%, 11.8%, and 20% in ACCI B 5 group, 47.2%, 13.9%, and 38.9% in ACCI = 6 group, and 27.3%, 9.1%, and 63.6% in ACCI C 7 group (p = 0.053; ACCI B 5 vs. = 6, p = 0.19; ACCI = 6 vs. C 7, p \ 0.001; ACCI B 5 vs. C 7). In terms of the treatment for HCC recurrence in ACCI B 5, ACCI = 6, and ACCI C 7 groups, adaptation rate of surgical resection was 20.1%, 7.3%, and 11.1% and the rate of palliative therapy was 4.3%, 12.2%, and 22.2%, respectively. Conclusions The ACCI predicted the short-term and long-term outcomes after hepatic resection of HCC. These findings will help physicians establish a treatment strategy for HCC patients with comorbidities.

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“…In recent years, postoperative complications, such as bleeding, bile leakage, ascites, liver failure, infection and need of reoperation were shown to significantly impair overall and cancer-specific outcome following liver resection for HCC [119][120][121] . In the LT setting, surgical complications reduce the overall prognosis in HCC patients.…”

Section: Perioperative Complicationsmentioning

confidence: 99%

Liver transplantation for hepatocellular carcinoma - non-cancer factors and implications for improving outcome beyond standard tumor criteria

Kornberg¹,

Schernhammer²

2018

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How to cite this article: Kornberg A, Schernhammer M. Liver transplantation for hepatocellular carcinoma -non-cancer factors and implications for improving outcome beyond standard tumor criteria. Hepatoma Res 2018;4:60. http://dx. AbstractLiver transplantation (LT) is recognized as best treatment option in patients with early hepatocellular cancer (HCC) in underlying liver cirrhosis. Apart from tumor size and number implemented in the Milan criteria, which are current worldwide standards for patient selection, several biological tumor factors have been identified to affect cancer-specific outcome. In particular, grading and vascular tumor invasions were shown to correlate with aggressive biological tumor behavior and poor survival following LT. Identifying tumors with favorable biology is one important approach for expanding the pool of eligible liver recipients beyond the Milan burden limits. Improving the immunological state and condition for appropriate defense against circulating cancer cell attack may be another important prognostic aspect. Therefore, there is increasing interest in non-cancer factors related to the peritransplant period that may influence the oncological outcome by providing negative immunomodulatory actions. Considering and modulation of these non-HCC factors of prognosis might contribute in safely expanding the HCC LT selection criteria.

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Differential significance of early surgical complications for acute and long-term recurrence-free survival following surgical resection of hepatocellular carcinoma: do comorbidities play a role?

Abstract: In patients with HCC, posthepatectomy complications are confirmed to have predictive value. However, closer analysis and exclusion of perioperative mortality effects show an independent impact of pre-existing comorbidities on long-term overall und recurrence-free survival.

Cited by 13 publications

References 38 publications

Chances, challenges and outcomes of patients with complex bilobar colorectal liver metastases approached by a combined multimodal therapy with liver resection and local ablative therapy

Chances, challenges and outcomes of patients with complex bilobar colorectal liver metastases approached by a combined multimodal therapy with liver resection and local ablative therapy

Predictive Value of the Age‐Adjusted Charlson Comorbidity Index for Outcomes After Hepatic Resection of Hepatocellular Carcinoma

Liver transplantation for hepatocellular carcinoma - non-cancer factors and implications for improving outcome beyond standard tumor criteria

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