Early and resectable HCC: Definition and validation of a subgroup of patients who could avoid liver transplantation

Scatton, Olivier; Goumard, Claire; Cauchy, François; Fartoux, Lætitia; Perdigao, Fabiano; Conti, Filoména; Calmus, Yvon; Boëlle, Piérre Yves; Belghiti, Jacques; Rosmorduc, Olivier; Soubrane, Olivier

doi:10.1002/jso.23916

Cited by 18 publications

(15 citation statements)

References 34 publications

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“…Clinical and biological data have been collected for each patient at the time of LR. The selection criteria have been detailed elsewhere . Briefly, all patients had to meet the criteria for LR, that is, preserved liver function and general status, MELD score <9, Child‐Pugh class A or B, tumour size, number, location, no macrovascular involvement.…”

Section: Methodsmentioning

confidence: 99%

Temporal trends, clinical patterns and outcomes of NAFLD‐related HCC in patients undergoing liver resection over a 20‐year period

Pais

Fartoux

Goumard

et al. 2017

Aliment Pharmacol Ther

108

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Section: Methodsmentioning

confidence: 99%

Temporal trends, clinical patterns and outcomes of NAFLD‐related HCC in patients undergoing liver resection over a 20‐year period

Pais

Fartoux

Goumard

et al. 2017

Aliment Pharmacol Ther

108

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“…However, only a minority of patients qualify for curative treatments because of advanced liver disease, intrahepatic tumour distribution or comorbidities . Even potentially “ideal” transplant candidates may not go on to have the surgery they would actually require, with many transplant centres rarely adopting OLT as a first‐line option for very early or early HCC . Furthermore, as resection or ablation do not preclude salvage OLT in case of treatment failure, the use of initially less invasive strategies is often favoured .…”

Section: Introductionmentioning

confidence: 99%

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Lachenmayer

Tinguely

Maurer

et al. 2019

Liver International

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Background & Aims:Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency. Methods: Retrospective analysis of patients treated with stereotactic image-guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet-ventilation. Results: In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm.Median one tumour (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174).Close proximity to major vessels was significantly correlated with local tumour progression (P < .05). Median overall follow-up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P < .05). Conclusion:Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations. K E Y W O R D Shepatocellular carcinoma, microwave ablation, navigation, stereotactic

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“…For some resectable HCC, surgical resection is comparable with liver transplantation on the long-term prognosis and more affordable on physical, psychological or economic conditions. [8,9] However, the high incidence of tumor recurrence accounts for the major cause of death after operation. [10,11] In order to reduce the recurrence rate, postoperative TACE could remarkably improve the prognosis of patients.…”

Section: Introductionmentioning

confidence: 99%

Preoperative transarterial chemoembolization for resectable hepatocellular carcinoma in Asia area: a meta-analysis of random controlled trials

Chen

et al. 2016

Scandinavian Journal of Gastroenterology

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Objective: We aimed to systematically evaluate the influence of preoperative transarterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) on long-term prognosis and perioperative safety. Materials and methods: Databases including PubMed, Embase, Cochrane, Wanfang, CNKI, VIP data were searched, combined with Manual Retrieval and Cited Reference Search to collect the published randomized controlled trial (RCT) about the influence of pre-TACE for curative resection of HCC. The searching cutoff date was 2016/02/25, all the data obtained were statistically analyzed using RevMan5.2 software recommended by Cochrane Collaboration. Results: A total of 5 RCT including 430 (pre-TACE group: 212, surgery alone group: 218) patients were included. The results of meta-analysis showed that: there was no difference between the 2 groups on overall survival (OS) rate [HR 1.25, 95%CI (0.92–1.68)], disease free survival (DFS) rate [HR 0.95 (0.76–1.19)], perioperative mortality rate [OR 0.70 (0.22–2.30)], or blood loss [SMD 0.07 (−0.14–0.29)], whereas the subgroup analysis revealed that pre-TACE would result in longer operation time [SMD 0.31 (0.06–0.57)], higher postoperative morbidity rate [OR 1.90 (1.02–3.53)] and combined resection rate of perihepatic organs [OR 5.46 (2.73–11.78)] in subgroup with mean tumor diameter >5cm. Conclusions: According to our study, pre-TACE treatment cannot improve the long-term prognosis of resectable HCC. With the growth of the tumor diameter, especially when it is over 5cm, it might add difficulties to surgery and affect the perioperative safety.

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Early and resectable HCC: Definition and validation of a subgroup of patients who could avoid liver transplantation

Abstract: In a group of early HCC patients gathering all factors of GP, primary LR achieves at least similar survival as upfront LT and should be the approach of choice.

Cited by 18 publications

References 34 publications

Temporal trends, clinical patterns and outcomes of NAFLD‐related HCC in patients undergoing liver resection over a 20‐year period

Temporal trends, clinical patterns and outcomes of NAFLD‐related HCC in patients undergoing liver resection over a 20‐year period

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Preoperative transarterial chemoembolization for resectable hepatocellular carcinoma in Asia area: a meta-analysis of random controlled trials

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