New frontiers in liver resection for hepatocellular carcinoma

Allaire, Manon; Goumard, Claire; Lim, Chetana; Cleach, Aline Le; Wagner, Mathilde; Scatton, Olivier

doi:10.1016/j.jhepr.2020.100134

Cited by 61 publications

(65 citation statements)

References 185 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Liver resection is the treatment of choice in noncirrhotic patients and one of the main curative options for early HCC in selected patients with cirrhosis[ 141 - 144 ]. In the last decades, improved surgical techniques and perioperative management as well as improved patient selection have enabled the indications for liver resection to be expanded[ 145 - 148 ]. In a nationwide study using the National Surgical Quality Improvement Program database to investigate the impact of CKD and ESRD on outcomes following major abdominal surgery, 24572 patients were included, of whom only 149 (0.6%) were on hemodialysis preoperatively.…”

Section: Challenges Of Treating Hcc In Patients With Renal Dysfunctionmentioning

confidence: 99%

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Yeh¹,

Chiang²,

Yen³

2021

WJG

View full text Add to dashboard Cite

The population of patients with hepatocellular carcinoma (HCC) overlaps to a high degree with those for chronic kidney disease (CKD) and end-stage renal disease (ESRD). The degrees of renal dysfunction vary, from the various stages of CKD to dialysis-dependent ESRD, which often affects the prognosis and treatment choice of patients with HCC. In addition, renal dysfunction makes treatment more difficult and may negatively affect treatment outcomes. This study summarized the possible causes of the high comorbidity of HCC and renal dysfunction. The possible mechanisms of CKD causing HCC involve uremia itself, long-term dialysis status, immunosuppressive agents for postrenal transplant status, and miscellaneous factors such as hormone alterations and dysbiosis. The possible mechanisms of HCC affecting renal function include direct tumor invasion and hepatorenal syndrome. Finally, we categorized the risk factors that could lead to both HCC and CKD into four categories: Environmental toxins, viral hepatitis, metabolic syndrome, and vasoactive factors. Both CKD and ESRD have been reported to negatively affect HCC prognosis, but more research is warranted to confirm this. Furthermore, ESRD status itself ought not to prevent patients receiving aggressive treatments. This study then adopted the well-known Barcelona Clinic Liver Cancer guidelines as a framework to discuss the indicators for each stage of HCC treatment, treatment-related adverse renal effects, and concerns that are specific to patients with pre-existing renal dysfunction when undergoing aggressive treatments against CKD and ESRD. Such aggressive treatments include liver resection, simultaneous liver kidney transplantation, radiofrequency ablation, and transarterial chemoembolization. Finally, focusing on patients unable to receive active treatment, this study compiled information on the latest systemic pharmacological therapies, including targeted and immunotherapeutic drugs. Based on available clinical studies and Food and Drug Administration labels, this study details the drug indications, side effects, and dose adjustments for patients with renal dysfunction. It also provides a comprehensive review of information on HCC patients with renal dysfunction from disease onset to treatment.

show abstract

Section: Challenges Of Treating Hcc In Patients With Renal Dysfunctionmentioning

confidence: 99%

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Yeh¹,

Chiang²,

Yen³

2021

WJG

View full text Add to dashboard Cite

show abstract

“…CSPH is a well‐identified predictive factor for liver decompensation and death after liver resection. Currently, optimal surgical candidacy for resection is based on a multiparametric evaluation including compensated Child‐Pugh class A liver function with MELD score <10, to be matched with grade of PHT, acceptable remaining parenchyma and the possibility of a laparoscopic/minimally invasive approach 6,65 . CSPH is also associated with decrease overall survival after ablation and chemoembolization 66,67 .…”

Section: A Link Between Hepatocellular Carcinoma and Portal Hypertensionmentioning

confidence: 99%

“…Currently, optimal surgical candidacy for resection is based on a multiparametric evaluation including compensated Child-Pugh class A liver function with MELD score <10, to be matched with grade of PHT, acceptable remaining parenchyma and the possibility of a laparoscopic/minimally invasive approach. 6,65 CSPH is also associated with decrease overall survival after ablation and chemoembolization. 66,67 Moreover, the presence of clinically significant ascites precludes any locoregional of systemic therapy.…”

Section: A Link B E T Ween Hepato Cellul Ar C Arcinoma and P Ortal Hypertens Ionmentioning

confidence: 99%

Portal hypertension and hepatocellular carcinoma: Des liaisons dangereuses…

Allaire

Rudler

Thabut

2021

Liver International

Self Cite

View full text Add to dashboard Cite

Background and Aims Portal hypertension (PHT) and hepatocellular carcinoma (HCC) are major complication of cirrhosis which significantly contribute to morbidity and mortality. In this review, we aim to describe the consequences of both angiogenesis and inflammation in the pathogenesis of PHT and HCC, but also the difficulty to propose adapted treatment when PHT and HCC coexist in the same patients. Methods Studies for review in this article were retrieved from the PubMed database using literature published in English until March 2021. Results Portal hypertension occurs secondary to an increase of intrahepatic vascular resistances, the opening of portosystemic collateral vessels and the formation of neovessels, related to vascular endothelial growth factor (VEGF). Recently, bacterial translocation‐mediated inflammation was also identified as a major contributor to PHT. Interestingly, VEGF and chronic inflammation also contribute to HCC occurrence. As PHT and HCC often coexist in the same patient, management of PHT and its related complications as well as HCC treatment appear more complex. Indeed, PHT‐related complications such as significant ascites may hamper the access to HCC treatment and the presence of HCC is also independently associated with poor prognosis in patients with acute variceal bleeding related to PHT. Due to their respective mechanism of action, the combination of Atezolizumab and Bevacizumab for advanced HCC may impact the level of PHT and its related complications and to date, no real‐life data are available. Conslusions Appropriate evaluation and treatment of PHT remains a major issue in order to improve the outcome of HCC patients.

show abstract

“…Surgical resection is one of the primary curative-intent options in HCC with many neoadjuvant treatments aimed at downstaging tumors in advance of resection. Unfortunately, there is an approximately 70% risk of recurrence at 5 years after resection (22), and for this reason adjuvant chemotherapy (AC) has been explored as a method to improve recurrence free survival (RFS) and OS both after partial hepatectomy as well as liver transplant. Some of these AC approaches have evaluated concurrent systemic and locally directed chemotherapeutic agents.…”

Section: Cytotoxic Agentsmentioning

confidence: 99%

Neoadjuvant and adjuvant treatment approaches for hepatocellular carcinoma: future outlook

Şahin¹,

Khalil²,

Millett³

et al. 2021

Chin Clin Oncol

View full text Add to dashboard Cite

Hepatocellular carcinoma (HCC) is a highly aggressive and chemotherapy resistant cancer with unique biologic characteristics which makes this disease highly different than other gastrointestinal cancers. The mainstay of curative treatment in HCC is surgical resection, ablation, and transplantation. However, rates of recurrence are high and many patients are not initially candidates for these curative approaches. This paper discusses predictors of recurrence of HCC in patients who have undergone surgical resection and addresses adjuvant therapies aimed at decreasing recurrence risk and improving overall survival (OS) outcomes, including traditional cytotoxic chemotherapies, tyrosine kinase inhibitors (TKIs), and immunotherapy. This article also discusses neoadjuvant strategies aimed at improving recurrence rate and OS as well as downstaging advanced HCC to enable surgical disease, including locoregional therapies, systemic chemotherapy, TKIs, and immune checkpoint inhibitors. Finally, this article addresses potential future directions for both adjuvant and neoadjuvant therapies that may change the treatment paradigm of HCC in the near future.

show abstract

New frontiers in liver resection for hepatocellular carcinoma

Cited by 61 publications

References 185 publications

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Portal hypertension and hepatocellular carcinoma: Des liaisons dangereuses…

Neoadjuvant and adjuvant treatment approaches for hepatocellular carcinoma: future outlook

Contact Info

Product

Resources

About