Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension

Azoulay, Daniel; Ramos, Emilio; Casellas-Robert, Margarida; Salloum, Chady; Lladó, Laura; Nadler, Roy; Busquets, Juli; Caula-Freixa, Cèlia; Mils, Kristel; López‐Ben, Santiago; Figueras, Joan; Lim, Chetana

doi:10.1016/j.jhepr.2020.100190

Cited by 39 publications

(38 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent multicentric study showed that cirrhotic patients with a hepatic venous pressure gradient of ten or more could undergo liver resection with an acceptable 90-day perioperative mortality and morbidity (6% and 27%, respectively) and persistent liver decompensation (10% at 3 months) (7). In many Asian studies, the extent of surgery was applied where technically feasible, including in patients with macrovascular invasion (33,34).…”

Section: Discussionmentioning

confidence: 99%

“…Resection is recommended for those at BCLC stage 0 or BCLC-A with a solitary nodule (4,5). Additionally, the patient must be an optimal candidate meeting the following criteria: compensated Child-Pugh class A liver function, model for endstage liver disease (MELD) score of <10, and matched grade portal hypertension (4,6,7). In Asia, the classification system is designed to detect HCC earlier with higher sensitivity and lower specificity (8).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

How important is the role of iterative liver direct surgery in patients with hepatocellular carcinoma for a transplant center located in an area with a low rate of deceased donation?

Pagano

Khouzam²,

Magro³

et al. 2022

Front. Oncol.

View full text Add to dashboard Cite

IntroductionHepatocellular carcinoma (HCC) accounts for nearly 90% of primary liver cancers, with estimates of over 1 million people affected by 2025. We aimed to explore the impacting role of an iterative surgical treatment approach in a cohort of HCC patients within the Milan criteria, associated with clinical risk factors for tumor recurrence (RHCC) after liver transplant (LT) and loco-regional therapies (LRT), as well as liver resection (LR) and/or microwave thermal ablation (MWTA).MethodsWe retrospectively analyzed our experience performed during an 8-year period between January 2013 and December 2021 in patients treated for HCC, focusing on describing the impact on preoperative end-stage liver disease severity, oncologic staging, tumor characteristics, and surgical treatments. The Cox model was used to evaluate variables that could predict relapse risks. Relapse risk curves were calculated according to the Kaplan–Meier method, and the log-rank test was used to compare them.ResultsThere were 557 HCC patients treated with a first-line approach of LR and/or LRTs (n = 335) or LT (n = 222). The median age at initial transplantation was 59 versus 68 for those whose first surgical approach was LR and/or LRT. In univariate analysis with the Cox model, nodule size was the single predictor of recurrence of HCC in the posttreatment setting (HR: 1.61, 95% CI: 1.05–2.47, p = 0.030). For the LRT group, we have enlightened the following clinical characteristics as significantly associated with RHCC: hepatitis B virus infection (which has a protective role with HR: 0.34, 95% CI: 0.13–0.94, p = 0.038), number of HCC nodules (HR: 1.54, 95% CI: 1.22–1.94, p < 0.001), size of the largest nodule (HR: 1.06, 95% CI: 1.01–1.12, p = 0.023), serum bilirubin (HR: 1.57, 95% CI: 1.03–2.40, p = 0.038), and international normalized ratio (HR: 16.40, 95% CI: 2.30–118.0, p = 0.006). Among the overall 111 patients with RHCC in the LRT group, 33 were iteratively treated with further curative treatment (12 were treated with LR, two with MWTA, three with a combined LR-MWTA treatment, and 16 underwent LT). Only one of 18 recurrent patients previously treated with LT underwent LR. For these RHCC patients, multivariable analysis showed the protective roles of LT for primary RHCC after IDLS (HR: 0.06, 95% CI: 0.01–0.36, p = 0.002), of the time relapsed between the first and second IDLS treatments (HR: 0.97, 95% CI: 0.94–0.99, p = 0.044), and the impact of previous minimally invasive treatment (HR: 0.28, 95% CI: 0.08–1.00, p = 0.051).ConclusionThe coexistence of RHCC with underlying cirrhosis increases the complexity of assessing the net health benefit of ILDS before LT. Minimally invasive surgical therapies and time to HCC relapse should be considered an outcome in randomized clinical trials because they have a relevant impact on tumor-free survival.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How important is the role of iterative liver direct surgery in patients with hepatocellular carcinoma for a transplant center located in an area with a low rate of deceased donation?

Pagano

Khouzam²,

Magro³

et al. 2022

Front. Oncol.

View full text Add to dashboard Cite

show abstract

“…According to this hierarchical interaction (portal pressure + extent of resection + MELD score), HVPG > 10 mmHg or indirect evidence of CSPH are no longer an absolute contraindication for HCC resection in patients with cirrhosis, if MELD is below 10 and the resection limited. Other studies which included patients with HVPG > 10 mmHg found an acceptable risk of PHLF of about 5-30%, with an acceptable 36-month survival (about 75%) [19]. In the case of HVPG > 10 mmHg, we should select those with a good performance status (PS 0-1), with preserved liver function (MELD <10), and without any sign of clinical decompensation of liver cirrhosis (only Child A5-6), including the absence of esophageal varices.…”

Section: Predictors Of Post-hepatectomy Liver Failurementioning

confidence: 94%

Hepatological Evaluation and Biomarkers

Giannelli

Demma

Pellicelli

et al. 2022

Hepatocellular Carcinoma

View full text Add to dashboard Cite

“…With the development of artificial intelligence and information, deep convolutional neural network has been used in the segmentation of medical images, and its performance is far superior to traditional machine learning algorithms [11,12]. Souhami et al [13] proposed a 3D deep full convolutional neural network (FCNN) architecture to segment the lesions in MRI images of the prostate gland by combining the characteristics of the lesions and the information of its surrounding tissues.…”

Section: Introductionmentioning

confidence: 99%

Automatic Segmentation Algorithm of Magnetic Resonance Image in Diagnosis of Liver Cancer Patients under Deep Convolutional Neural Network

Zhang

Zhao

2021

Scientific Programming

View full text Add to dashboard Cite

To study the influence of different sequences of magnetic resonance imaging (MRI) images on the segmentation of hepatocellular carcinoma (HCC) lesions, the U-Net was improved. Moreover, deep fusion network (DFN), data enhancement strategy, and random data (RD) strategy were introduced, and a multisequence MRI image segmentation algorithm based on DFN was proposed. The segmentation experiments of single-sequence MRI image and multisequence MRI image were designed, and the segmentation result of single-sequence MRI image was compared with those of convolutional neural network (FCN) algorithm. In addition, RD experiment and single-input experiment were also designed. It was found that the sensitivity (0.595 ± 0.145) and DSC (0.587 ± 0.113) obtained by improved U-Net were significantly higher than the sensitivity (0.405 ± 0.098) and DSC (0.468 ± 0.115, P < 0.05 ) obtained by U-Net. The sensitivity of multisequence MRI image segmentation algorithm based on DFN (0.779 ± 0.015) was significantly higher than that of FCN algorithm (0.604 ± 0.056, P < 0.05 ). The multisequence MRI image segmentation algorithm based on the DFN had higher indicators for liver cancer lesions than those of the improved U-Net. When RD was added, it not only increased the DSC of the single-sequence network enhanced by the hepatocyte-specific magnetic resonance contrast agent (Gd-EOB-DTPA) by 1% but also increased the DSC of the multisequence MRI image segmentation algorithm based on DFN by 7.6%. In short, the improved U-Net can significantly improve the recognition rate of small lesions in liver cancer patients. The addition of RD strategy improved the segmentation indicators of liver cancer lesions of the DFN and can fuse image features of multiple sequences, thereby improving the accuracy of lesion segmentation.

show abstract

Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension

Cited by 39 publications

References 43 publications

How important is the role of iterative liver direct surgery in patients with hepatocellular carcinoma for a transplant center located in an area with a low rate of deceased donation?

How important is the role of iterative liver direct surgery in patients with hepatocellular carcinoma for a transplant center located in an area with a low rate of deceased donation?

Hepatological Evaluation and Biomarkers

Automatic Segmentation Algorithm of Magnetic Resonance Image in Diagnosis of Liver Cancer Patients under Deep Convolutional Neural Network

Contact Info

Product

Resources

About