Hepatic resection for bilobar multicentric hepatocellular carcinoma: Is it justified?

Wu, Cheng‐Chung; Ho, William-Lin; Lin, Min-Che; Yeh, Dah-Cherng; Wu, Hurng‐Sheng; Hwang, C. R.; Liu, Tse‐Jia; P’eng, Fang-Ku

doi:10.1016/s0039-6060(98)70179-5

Cited by 42 publications

(8 citation statements)

References 14 publications

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Section: Oncological Efficacymentioning

confidence: 99%

“…HCC is associated with a high incidence of intrahepatic metastasis and multicentric occurrence associated with underlying chronic liver disease caused by hepatitis B or C. Hepatectomy is the standard therapeutic modality and has the highest cure rate compared to other treatments, although the rate of postoperative recurrence remains high. [16][17][18] If there is a risk of postoperative liver failure, the choice of treatment for HCC must be based on the underlying chronic liver disease. Nonsurgical treatments such as percutaneous ethanol injection, 19,20 ablation (microwave or radiofrequency) therapy, [21][22][23][24] and transcatheter arterial embolization (TAE) 25 have been widely indicated in view of the quality of life (QOL) and minimal invasiveness they allow, thus provoking controversy between these options and hepatectomy.…”

Section: Oncological Efficacymentioning

confidence: 99%

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Laparoscopic hepatectomy: indications and outcomes

Kaneko

2005

J Hepatobiliary Pancreat Surg

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We outline the indications, evaluate the degree of invasiveness, and analyze the outcomes of laparoscopic hepatectomy, mainly in the treatment of hepatocellular carcinoma (HCC). The important considerations in determining indications for laparoscopic hepatectomy include tumor size, type, and location. Nodular tumors smaller than 4 cm or pedunculated tumors smaller than 6 cm are suitable candidates. Concerning location, tumors in the lower segment or the left lateral segment are suitable. Regarding operative method, laparoscopic hepatectomy involving either partial hepatectomy or left lateral segmentectomy is a feasible, less invasive procedure. Operative time in our recent laparoscopic hepatectomy patients has decreased, with less bleeding. Furthermore, laparoscopic hepatectomy is less invasive than conventional hepatectomy on evaluation by the Estimation of Physiolic Ability and Surgical Stress (E-PASS) scoring system. Patients recovered more quickly after laparoscopic hepatectomy, which allowed shorter hospitalization. Both the 5-year survival rate for HCC and the survival rate without recurrence were nearly identical to those of open conventional hepatectomy, although further analysis will be necessary to reach definitive conclusions. In conclusion, laparoscopic hepatectomy avoids the disadvantages of standard hepatectomy in properly selected patients and is beneficial for patient quality of life, because it is a minimally invasive procedure when indications are strictly followed.

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Section: Oncological Efficacymentioning

confidence: 99%

Section: Oncological Efficacymentioning

confidence: 99%

Laparoscopic hepatectomy: indications and outcomes

Kaneko

2005

J Hepatobiliary Pancreat Surg

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“…6,7 Furthermore, the lymph node involvement cannot be established on the basis of the macroscopic evidence, because swollen nodes can be consequences of the chronic liver disease: therefore, for estimation of the N factor, pathological diagnosis is needed.…”

Section: Tnm/uicc Classificationmentioning

confidence: 99%

IHPBA concordant classification of primary liver cancer: working group report

Makuuchi¹,

Belghiti²,

Belli³

et al. 2003

J Hepatobiliary Pancreat Surg

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The working group of the International Scientific Committee of the International Hepato‐Pancreato‐Biliary Association (IHPBA) examined conventional staging systems and decided to establish a new staging system that depended on macroscopic findings after liver resection. The TNM/International Union Against Cancer (UICC) classification has been widely used but is too complicated. Vauthey and colleagues, and the Liver Cancer Study Group of Japan (LCSGJ) have proposed new simplified classifications. These are compared and discussed. The IHPBA working group proposed a new classification, as follows. T factor: Solitary No more than 2 cm No vascular invasion to portal vein, hepatic vein, and bile duct T1 meets all of the above three requirements. T2 meets two of the three requirements. T3 meets one of the three requirements. T4 does not meet any requirements. Stage: IT1N0M0IIT2N0M0IIIT3N0M0IV AT4N0M0Any TN1M0IV BAny T/N, M1 The survival curves of each stage were separated clearly (P < 0.0001). The staging system is easy to remember and easy to use. We hope this staging system will be generally used in future.

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“…Surgery is the most effective treatment for hepatocellular carcinoma (HCC) . The results of liver resection have improved over the last decade with improvements in surgical technique .…”

Section: Introductionmentioning

confidence: 99%

Microwave coagulation therapy for hepatocellular carcinoma

Midorikawa

Kumada

Kikuchi

et al. 2000

Journal of Hepato-Biliary-Pancreatic Surgery

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The efficacy and safety of microwave coagulation therapy (MCT) in patients with hepatocellular carcinoma (HCC) and impaired hepatic reserve were studied. Preoperative background factors, postoperative results, and prognostic factors were compared in 51 patients who underwent hepatic resection (HR group) and 38 patients who underwent microwave coagulation therapy (MCT group). Before surgery, measures of hepatic function, including level of albumin (P = 0.0072), prothrombin time (P<0.0001), hepaplastin test (P = 0.0088), and the radioactivity of technetium-99m galactosyl-human serum albumin 15 min in the liver after injection divided by that in both liver and heart (P <0.0001) were significantly lower in the MCT group than in the HR group. The indocyanine green dye retention rate at 15 min was significantly greater (P<0.0001) in the MCT group than in the HR group, and a significant difference was noted in Child-Pugh grade between the groups (P<0.0001). Operative time (P = 0.0014) and blood loss during surgery (P = 0.0005) were significantly lower in the MCT group than in the HR group. In contrast, no significant differences were recognized between the groups in the changes in postoperative liver function, or in the rates of morbidity, mortality, local recurrence, and survival. Moreover, the type of treatment (HR or MCT) was not a prognostic factor. The results indicate that MCT can be used safely as an alternative to hepatic resection in patients with poor liver function without reducing the efficacy of local control.

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Hepatic resection for bilobar multicentric hepatocellular carcinoma: Is it justified?

Cited by 42 publications

References 14 publications

Laparoscopic hepatectomy: indications and outcomes

Laparoscopic hepatectomy: indications and outcomes

IHPBA concordant classification of primary liver cancer: working group report

Microwave coagulation therapy for hepatocellular carcinoma

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