Laparoscopic liver resection for hepatocellular carcinoma in early and advanced cirrhosis

Beard, Rachel E.; Wang, Yisi; Khan, Sidrah; Marsh, J. Wallis; Tsung, Allan; Geller, David A.

doi:10.1016/j.hpb.2017.11.011

Cited by 28 publications

(14 citation statements)

References 34 publications

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“…According to the most recent experiences, LR may improve the survival of Child-Pugh B and BCLC B carcinoma when patients are carefully selected and surgery is performed in specialized centers. Moreover, the mini-invasive approach allows pushing up the limits of LR in this stage of the disease[ 75 , 82 ]. Consequently, indications for resection could be expanded to include patients from therapies associated with satisfactory results.…”

Section: Discussionmentioning

confidence: 99%

Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery?

Romano¹,

Chiarelli²,

Garancini³

et al. 2021

WJG

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According to Barcelona Clinic Liver Cancer recommendations, intermediate stage hepatocellular carcinomas (stage B) are excluded from liver resection and are referred to palliative treatment. Moreover, Child-Pugh B patients are not usually candidates for liver resection. However, many hepatobiliary centers in the world manage patients with intermediate stage hepatocellular carcinoma or Child-Pugh B cirrhosis with liver resection, maintaining that hepatic resection is not contraindicated in selected patients with non–early-stage hepatocellular carcinoma and without normal liver function. Several studies demonstrate that resection provides the best survival benefit for selected patients in very early/early and even in intermediate stages of Barcelona Clinic Liver Cancer classification, and this treatment gives good results in the setting of multinodular, large tumors in patients with portal hypertension and/or Child-Pugh B cirrhosis. In this review we explore this controversial topic, and we show through the literature analysis how liver resection may improve the short- and long-term survival rate of carefully selected Barcelona Clinic Liver Cancer B and Child-Pugh B hepatocellular carcinoma patients. However, other large clinical studies are needed to clarify which patients with intermediate stage hepatocellular carcinoma are most likely to benefit from liver resection.

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Section: Discussionmentioning

confidence: 99%

Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery?

Romano¹,

Chiarelli²,

Garancini³

et al. 2021

WJG

View full text Add to dashboard Cite

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“…In addition, liver cirrhosis is one of the most common inducing factors of hepatocarcinogenesis and also directly indicates the feasibility of operation (15,16). With the development of surgical techniques, some HCC patients with advanced cirrhosis also could achieve curative LR on the premise of perioperative safety (17,18). However, few studies have explored the impact of surgical margin on the long-term prognosis of those patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of Surgical Margin on the Prognosis of Early Hepatocellular Carcinoma (≤5 cm): A Propensity Score Matching Analysis

Wang

Qian

et al. 2020

Front. Med.

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The influence of surgical margin on the prognosis of patients with early solitary hepatocellular carcinoma (HCC) (≤5 cm) is undetermined.Methods: The data of 904 patients with early solitary HCC who underwent liver resection were collected for recurrence-free survival (RFS) and overall survival (OS). Propensity score matching (PSM) was performed to balance the potential bias.Results: Log-rank tests showed that 2 mm was the best cutoff value to discriminate the prognosis of early HCC. Liver resection with a >2 mm surgical margin distance (wide-margin group) led to better 5-year RFS and OS rate compared with liver resection with a ≤2 mm surgical margin distance (narrow-margin group) among patients both before (RFS: 59.1% vs. 39.6%, P < 0.001; OS: 85.3% vs. 73.7%, P < 0.001) and after PSM (RFS: 56.3% vs. 41.0%, P < 0.001; OS: 83.0% vs. 75.0%, P = 0.010). Subgroup analysis showed that a wide-margin resection significantly improved the prognosis of patients with microvascular invasion (RFS: P < 0.001; OS: P = 0.001) and patients without liver cirrhosis (RFS: P < 0.001; OS: P = 0.001) after PSM. Multivariable Cox regression analysis revealed that narrow-margin resection is associated with poorer RFS [hazard ratio (HR) = 1.781, P < 0.001), OS (HR = 1.935, P < 0.001], and early recurrence (HR = 1.925, P < 0.001).Conclusions: A wide-margin resection resulted in better clinical outcomes than a narrow-margin resection among patients with early solitary HCC, especially for those with microvascular invasion and without cirrhosis. An individual strategy of surgical margin should be formulated preoperation according to both tumor factors and background liver factors.

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“…Direct percutaneous approach of an hepatic lesion can be an advantage after extensive liver surgery or in cirrhotic livers, avoiding cumbersome liver mobilization or the interruption of collateral circulation. On the other hand, recent studies suggest a possible wider role for liver resection in patients with HCC and Child B liver cirrhosis [14]. The experience illustrated in this retrospective cohort derives from a period when there was no rigid pre-defined therapeutic pathway and in which the gold standard of liver resection or at least laparoscopic exploration was probably pursued in a more resolute fashion.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical possibilities in minimally invasive liver resections are increasing not only with parenchyma preserving approaches for CRLM but also with the proposal of liver resections for HCC in Child B liver cirrhosis [12][13][14]. As both the local efficacy of MWA and the technical possibilities of liver resection increase, while the morbidity of surgery diminishes, this separation line may blur.…”

Section: Discussionmentioning

confidence: 99%

Local control of hepatocellular carcinoma and colorectal liver metastases after surgical microwave ablation without concomitant hepatectomy

Carvalho

Logghe

Cleven

et al. 2021

Langenbecks Arch Surg

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Purpose Microwave ablation (MWA) is an accepted technique in the multimodal treatment of hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM). Study endpoints were to evaluate the local efficacy of surgical MWA in selected patients with oligonodular disease without the combination of liver resection to allow a clear interpretation of the follow-up imaging and compare it to the results on percutaneous MWA available in the literature. Methods Consecutive MWA-only procedures performed between May 2013 and May 2018 for HCC and CRLM with free-hand ultrasound guidance were identified. MWA systems with 2450 MHz were used. Incomplete ablation (IA) was defined as residual disease within 1 cm of the ablation site at the first post-ablation imaging and local recurrence (LR) as the presence of disease after at least one tumor-free imaging. Results A total of 70 tumors in 47 patients were treated with 46 laparoscopic and 1 open procedures. Each patient had no more than 3 tumors, and median size of the lesions was 15 mm (IQR: 10-22). After a median follow-up of 26 months (IQR: 12-40), IA rate was 8.6% and LR rate was 29.4%. Multivariable analysis showed that vascular proximity (OR = 3.4; 95% CI = 1.26-9.22; p=0.016) was the only significant predictor of the combined outcome IA or LR. Discussion In the present study, after mostly laparoscopic MWA, LR was higher than the rates available in the literature for percutaneous MWA of HCC but lower than in the limited studies analyzing isolated percutaneous MWA of liver metastases. Future developments may help establish the role of each therapeutic modality per tumor, in order to improve the outcomes.

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Laparoscopic liver resection for hepatocellular carcinoma in early and advanced cirrhosis

Abstract: In carefully selected advanced cirrhotic patients, laparoscopic liver resection may be performed with acceptable outcomes. Though this is not yet well established, further trials may be warranted.

Cited by 28 publications

References 34 publications

Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery?

Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery?

Impact of Surgical Margin on the Prognosis of Early Hepatocellular Carcinoma (≤5 cm): A Propensity Score Matching Analysis

Local control of hepatocellular carcinoma and colorectal liver metastases after surgical microwave ablation without concomitant hepatectomy

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