Liver resection in Cirrhotic liver: Are there any limits?

Chan, Albert; Kow, Alfred Wei Chieh; Hibi, Taizo; Benedetto, Fabrizio Di; Serrablo, Alejandro

doi:10.1016/j.ijsu.2020.06.050

Cited by 23 publications

(32 citation statements)

References 97 publications

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“…Generally, patients with cirrhosis have a poorer hepatic function and are prone to have higher short-term postoperative mortality and morbidity than noncirrhotic patients. [7][8][9] Existing studies have indicated that cirrhotic liver results in a higher risk of hepatectomy liver failure due to insufficient functional liver remnant remains for maintaining postoperatively normal physiological functions. [9][10][11] Radical surgical resection is believed to be the only potentially curative management for patients with ICC, while a lower chance of receiving radical resection means Note: "N1-3″ indicated the patients underwent surgery and the number of LND in the range of 1-3, "N4 + " indicated the patients underwent surgery and the number of LND in the range of >4; PSM: propensity score matching.…”

Section: Resultsmentioning

confidence: 99%

Impact of cirrhosis on long‐term survival outcomes of patients with intrahepatic cholangiocarcinoma

et al. 2022

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Background:The correlation between cirrhosis and the long-term oncological outcome in intrahepatic cholangiocarcinoma (ICC) is debatable, and this study aimed to explore the impact of cirrhosis on the long-term prognosis of patients with ICC. Methods: A total of 398 ICC patients were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2018. The diagnosis of cirrhosis was based on the Ishak fibrosis score provided by the SEER database. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analysis were performed to minimize the potential confounders. Overall survival (OS) and cancer-specific survival (CSS) were observed, and the Cox regression model was used to select potential factors that affect the prognosis of the patients with ICC.Results: Of the included patients, there were 142 patients and 256 patients in the cirrhotic and noncirrhotic groups, respectively. Additionally, 299 of 398 patients (75.1%) died following a median follow-up of 19 months (interquartile range [IQR],7, 43). The OS and CSS indicated advantage trend in the noncirrhotic group than the cirrhotic group in either the original cohort (OS: 17 vs 12 months, p = 0.023; CSS: 26 vs 15 months, p = 0.004) or the PSM (OS: 17 vs 12 months, p = 0.52; CSS: 22 vs 14 months, p = 0.15) or IPTW (OS: 20 vs 13 months, p = 0.163; CSS: 22 vs 15 months, p = 0.059) cohorts. Subgroup analyses displayed that the prognosis of patients who experienced surgery for ICC in the noncirrhotic group was better than that of the cirrhotic group with regard to OS and CSS.Conclusions: Collectively, it seems that the noncirrhotic patients have similar relative OS but better CSS compared with that of the cirrhotic patients.

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Section: Resultsmentioning

confidence: 99%

Impact of cirrhosis on long‐term survival outcomes of patients with intrahepatic cholangiocarcinoma

et al. 2022

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“…Like HCC, cirrhosis was observed in the majority (62.5%) of CHC patients with known Metavir stage. The liver reserve function determines the choice of treatment to a great extent, and cirrhosis has been a well-recognized risk factor of postoperative liver failure, leading to poor outcomes for CHC patients (SHR = 2.004, 95% CI = 1.145–3.510, P =0.015) [ 56 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

Morbidity, Prognostic Factors, and Competing Risk Nomogram for Combined Hepatocellular-Cholangiocarcinoma

Chen

Shi

et al. 2021

Journal of Oncology

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Background. Combined hepatocellular-cholangiocarcinoma (CHC) is a rare and heterogeneous histological subtype of primary liver cancer, which is still poorly understood. This study aimed to describe the epidemiological and clinical features, investigate the prognostic indicators, and develop a competing risk nomogram for CHC. Methods. The study cohort was taken from the Surveillance, Epidemiology, and End Results database. The annual percent change (APC) in incidence was calculated using the joinpoint regression. The nomogram was developed based on multivariate competing risk survival analyses and validated by calibration curves. Akaike information criterion, Bayesian information criterion, Harrell’s C-index, and area under the receiver operating characteristic curves were obtained to compare prognostic performance. Decision curve analysis was introduced to examine the clinical value of the models. Results. The overall incidence of CHC was 0.062 per 100,000 individuals in 2004 and 0.081 per 100,000 individuals in 2018, with an APC of 1.0% ( P > 0.05 ). CHC displayed intermediate clinicopathological features of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Race, tumor size, vascular invasion, extrahepatic invasion, distant metastasis, grade, surgery, and Metavir stage were confirmed as the independent predictors of cancer-specific survival. The constructed nomogram was well calibrated, which showed better discrimination power and higher net benefits than the current American Joint Committee on Cancer staging system. Patients with liver transplantation had better survival than those with hepatectomy, especially patients within the Milan Criteria ( P = 0.022 and P = 0.015 ). There was no survival difference between liver transplantation and hepatectomy in patients beyond the Milan Criteria ( P = 0.340 ). Conclusion. The morbidity of CHC remained stable between 2004 and 2018. The constructed nomogram could predict the prognosis with good performance, which was meaningful to individual treatment strategies optimization. CHC patients should also be considered as potential liver transplantation recipients, especially those within the Milan Criteria, but the finding still needs more evidence to be further confirmed.

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“…Although the liver has a remarkable potential for regeneration, this regenerative capacity becomes impaired with serious liver fibrosis. ( 16 ) The transition of quiescent HSCs to activated, scar‐forming, myofibroblast‐like cells leads to excessive extracellular matrix synthesis. ( 17 , 18 ) This abnormal scar formation in the liver has been shown to hold back hepatocyte proliferation.…”

Section: Discussionmentioning

confidence: 99%

A Mesenchymal‐Epithelial Transition Factor‐Agonistic Antibody Accelerates Cirrhotic Liver Regeneration and Improves Mouse Survival Following Partial Hepatectomy

Que

et al. 2021

Liver Transpl

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Small‐for‐size syndrome (SFSS) is a common complication following partial liver transplantation and extended hepatectomy. SFSS is characterized by postoperative liver dysfunction caused by insufficient regenerative capacity and portal hyperperfusion and is more frequent in patients with preexisting liver disease. We explored the effect of the Mesenchymal‐epithelial transition factor (MET)‐agonistic antibody 71D6 on liver regeneration and functional recovery in a mouse model of SFSS. Male C57/BL6 mice were exposed to repeated carbon tetrachloride injections for 10 weeks and then randomized into 2 arms receiving 3 mg/kg 71D6 or a control immunoglobulin G (IgG). At 2 days after the randomization, the mice were subjected to 70% hepatectomy. Mouse survival was recorded up to 28 days after hepatectomy. Satellite animals were euthanized at different time points to analyze liver regeneration, fibrosis, and inflammation. Serum 71D6 administration significantly decreased mouse mortality consequent to insufficient regeneration of the cirrhotic liver. Analysis of liver specimens in satellite animals revealed that 71D6 promoted powerful activation of the extracellular signal‐regulated kinase pathway and accelerated liver regeneration, characterized by increased liver‐to‐body weight, augmented mitotic index, and higher serum albumin levels. Moreover, 71D6 accelerated the resolution of hepatic fibrosis as measured by picrosirius red, desmin, and α–smooth muscle actin staining, and suppressed liver infiltration by macrophages as measured by CD68 and F4/80 staining. Analysis of gene expression by reverse‐transcription polymerase chain reaction confirmed that 71D6 administration suppressed the expression of key profibrotic genes, including platelet‐derived growth factor, tissue inhibitor of metalloproteinase 3, and transforming growth factor‐β1, and of key proinflammatory genes, including tumor necrosis factor‐α, interleukin‐1β, chemokine (C‐C motif) ligand 3, and chemokine (C‐C motif) ligand 5. These results suggest that activating the MET pathway via an hepatocyte growth factor–mimetic antibody may be beneficial in patients with SFSS and possibly other types of acute and chronic liver disorders.

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Liver resection in Cirrhotic liver: Are there any limits?

Cited by 23 publications

References 97 publications

Impact of cirrhosis on long‐term survival outcomes of patients with intrahepatic cholangiocarcinoma

Impact of cirrhosis on long‐term survival outcomes of patients with intrahepatic cholangiocarcinoma

Morbidity, Prognostic Factors, and Competing Risk Nomogram for Combined Hepatocellular-Cholangiocarcinoma

A Mesenchymal‐Epithelial Transition Factor‐Agonistic Antibody Accelerates Cirrhotic Liver Regeneration and Improves Mouse Survival Following Partial Hepatectomy

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