Fully laparoscopic thermo-ablation of liver malignancies with or without liver resection: tumor location is an independent local recurrence risk factor

Ledoux, G.; Amroun, Kocéila; Rhaiem, Rami; Cagniet, A.; Aghaei, Arman; Bouché, Olivier; Hoeffel, Christine; Sommacale, Danièle; Piardi, Tullio; Kianmanesh, Réza

doi:10.1007/s00464-020-07456-0

Cited by 7 publications

(9 citation statements)

References 46 publications

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“…In fact, when a lesion is situated in the deeper segments, such as 4b, 7 and 8, the rate of successful bioptic sampling can be diminished due to the technical difficulties in reaching these less accessible locations [31,32]. Similarly, the precise definition of a tumour site allows its adjacency to large vessels, the biliary tree, the liver capsule or other important tissues, such as the diaphragm or gastrointestinal tracts, to be evaluated for the most appropriate and effective therapeutic choice, whether it is percutaneous or surgical [3,[15][16][17][18][19][20]. However, in addition to these technical and prognostic implications, only a few studies have analysed the spatial distribution of HCC with reference to Couinaud's segments [28].…”

Section: Discussionmentioning

confidence: 99%

“…For example, HCCs located in segment 4a (i.e., in a subcardiac location) are associated with a higher risk of ablation technical failure, essentially due to the continuous movement caused by cardiac motion during treatment [16]. Tumour locations in liver segments 4a, 8 and, particularly, 7 represent independent predictors of local recurrence after ablation due to a greater difficulty of probe positioning [17]. Moreover, the risk of microvascular invasion is 3.5 times higher when the HCC is located in segment 8 as compared to the other segments, using imaging for its preoperative identification as a prognostic factor [3].…”

Section: Introductionmentioning

confidence: 99%

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Segmental Distribution of Hepatocellular Carcinoma in Cirrhotic Livers

et al. 2022

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Background: To evaluate the segmental distribution of hepatocellular carcinoma (HCC) according to Couinaud’s anatomical division in cirrhotic patients. Methods: Between 2020 and 2021, a total of 322 HCC nodules were diagnosed in 217 cirrhotic patients who underwent computed tomography (CT) or magnetic resonance imaging (MRI) for the evaluation of suspicious nodules (>1 cm) detected during ultrasound surveillance. For each patient, the segmental position of the HCC nodule was recorded according to Couinaud’s description. The clinical data and nodule characteristics were collected. Results: A total of 234 (72.7%) HCC nodules were situated in the right lobe whereas 79 (24.5%) were detected in the left lobe (p < 0.0001) and only 9 nodules were in the caudate lobe (2.8%). HCC was most common in segment 8 (n = 88, 27.4%) and least common in segment 1 (n = 9, 2.8%). No significant differences were found in the frequencies of segmental or lobar involvement considering patient demographic and clinical characteristics, nodule dimension, or disease appearance. Conclusions: The intrahepatic distribution of HCC differs among Couinaud’s segments, with segment 8 being the most common location and segment 1 being the least common. The segmental distribution of tumour location was similar to the normal liver volume distribution, supporting a possible correlation between HCC location and the volume of hepatic segments and/or the volumetric distribution of the portal blood flow.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Segmental Distribution of Hepatocellular Carcinoma in Cirrhotic Livers

et al. 2022

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“…The proximity to the diaphragm was an independent predictor of local recurrence after ablation, as positioning the ablation probe was more difficult. 39 The recurrence rate of HCC following SR remains high, significantly impacting patient survival and prognosis. Studies have reported a recurrence rate of 50-70% at 5 years postsurgery.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, local recurrence of HCC in segments VII and VIII occurred after ablation. The proximity to the diaphragm was an independent predictor of local recurrence after ablation, as positioning the ablation probe was more difficult 39 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effectiveness of surgical resection and ablation for the treatment of early‐stage hepatocellular carcinoma: A retrospective cohort study

Yang,

Xi,

et al. 2024

Cancer Reports

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BackgroundThe optimal treatment strategy for early‐stage hepatocellular carcinoma (HCC) remains controversial, specifically in regard to surgical resection (SR) and ablation. The aim of this study was to investigate the impact of SR and ablation on recurrence and prognosis in early‐stage HCC patients, to optimize treatment strategies and improve long‐term survival.MethodsA retrospective analysis was conducted on 801 patients diagnosed with Barcelona Clinic Liver Cancer (BCLC) stage 0/A HCC and treated with SR or ablation between January 2015 and December 2019. The effectiveness and complications of both treatments were analyzed, and patients were followed up to measure recurrence and survival. Propensity score matching (PSM) was employed to increase comparability between the two groups. The Kaplan–Meier method was used to analyze recurrence and survival, and a Cox risk proportional hazard model was used to identify risk factors that affect recurrence and surviva.ResultsBefore PSM, the overall survival (OS) rates were similar in both groups, with recurrence‐free survival (RFS) rates better in the SR group than in the ablation group. After PSM, there was no significant difference in OS between the two groups. However, the RFS rates were significantly better in the SR group than in the ablation group. The ablation group exhibited superior outcomes compared to the SR group, with shorter treatment times, reduced bleeding, shorter hospital stays, and lower hospital costs. Concerning the location of the HCC within the liver, comparable efficacy was observed between SR and ablation for disease located in the noncentral region or left lobe. However, for HCCs located in the central region or right lobe of the liver, SR was more effective than ablation.ConclusionsThis study revealed no significant difference in OS between SR and ablation for early‐stage HCC, with SR providing better RFS and ablation demonstrating better safety profiles and lower hospital costs. These findings offer valuable insights for clinicians in determining optimal treatment strategies for early‐stage HCC patients, particularly in terms of balancing efficacy, safety, and cost considerations.

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“…Microwave ablation (MWA) comes with some advantages, these being cited by some authors, but with a lower usage than RFA[ 9 ]. Although feasible, with comparable outcomes with “conventional” open surgery, the combined treatment performed by a laparoscopic approach is not a standardized technique, with only a few reports being found in the literature[ 13 , 14 ].…”

Section: Combined Treatment To Facilitate Curementioning

confidence: 99%

Combined treatments in hepatocellular carcinoma: Time to put them in the guidelines?

Spârchez¹,

Radu²,

Bartoș³

et al. 2021

WJGO

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The time for battling cancer has never been more suitable than nowadays and fortunately against hepatocellular carcinoma (HCC) we do have a far-reaching arsenal. Moreover, because liver cancer comprises a plethora of stages-from very early to advanced disease and with many treatment options–from surgery to immunotherapy trials–it leaves the clinician a wide range of options. The scope of our review is to throw light on combination treatments that seem to be beyond guidelines and to highlight these using evidence-based analysis of the most frequently used combination therapies, discussing their advantages and flaws in comparison to the current standard of care. One particular combination therapy seems to be in the forefront: Transarterial chemoembolization plus ablation for medium-size non-resectable HCC (3-5 cm), which is currently at the frontier between Barcelona Clinic Liver Cancer classification A and B. Not only does it improve the outcome in contrast to each individual therapy, but it also seems to have similar results to surgery. Also, the abundance of immune checkpoint inhibitors that have appeared lately in clinical trials are bringing promising results against HCC. Although the path of combination therapies in HCC is still filled with uncertainty and caveats, in the following years the hepatology and oncology fields could witness an HCC guideline revolution.

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Fully laparoscopic thermo-ablation of liver malignancies with or without liver resection: tumor location is an independent local recurrence risk factor

Cited by 7 publications

References 46 publications

Segmental Distribution of Hepatocellular Carcinoma in Cirrhotic Livers

Segmental Distribution of Hepatocellular Carcinoma in Cirrhotic Livers

Evaluation of the effectiveness of surgical resection and ablation for the treatment of early‐stage hepatocellular carcinoma: A retrospective cohort study

Combined treatments in hepatocellular carcinoma: Time to put them in the guidelines?

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