No-Mortality Liver Resection for Hepatocellular Carcinoma in Cirrhotic and Noncirrhotic Patients

Torzilli, Guido; Makuuchi, Masatoshi; Inoue, Kazuto; Takayama, Tadatoshi; Sakamoto, Yoshihiro; Sugawara, Yasuhiko; Kubota, Keiichi; Zucchi, Alberto

doi:10.1001/archsurg.134.9.984

Cited by 450 publications

(367 citation statements)

References 65 publications

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“…clamping time of 39·3(16·9) min. Japanese authors have advocated perioperative steroid administration to reduce liver damage 11 by inhibiting membrane peroxidation (oxygen free radical cascade) and reducing cytokine release 19,20 . It has been shown that a single preoperative dose of methylprednisolone reduces postoperative production of IL-6 20,21 , an indicator of inflammatory status and the acute-phase response to surgery 4,7,22 .…”

Section: Discussionmentioning

confidence: 99%

“…Raised serum IL-6 levels have been correlated with higher postoperative mortality and morbidity rates 7 -9 , and it has been shown that perioperative steroid administration can lower IL-6 serum levels 7,10 . Routine perioperative steroid administration has been advocated to reduce hepatic ischaemic injury 11 .…”

Section: Introductionmentioning

confidence: 99%

“…Published data indicate a significant reduction in morbidity rates after liver resection with a perioperative steroid pulse 11 . This prospective randomized study examined the effects of an intravenous steroid pulse on postclamping ischaemic injuries and short-term outcome.…”

Section: Introductionmentioning

confidence: 99%

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Prospective randomized study of steroids in the preventionof ischaemic injury during hepatic resection with pedicle clamping

Muratore

Ribero

Ferrero

et al. 2003

British Journal of Surgery

107

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Background:The major drawback of hepatic pedicle clamping is ischaemia-reperfusion injury with impairment of liver function. Perioperative steroid administration has been advocated to reduce liver damage. The aim of this prospective, randomized study was to determine whether steroid administration can reduce liver injury and improve short-term outcome.Methods: Fifty-three patients undergoing liver resection were randomized to a steroid group (group 1) or to a control group (group 2); patients in group 1 received methylprednisolone 30 mg/kg 30 min before liver resection whereas those in group 2 did not. Serum levels of interleukin (IL) 6, total bilirubin, aspartate aminotransferase (AST) and alanine aminotransferase (ALT), and prothrombin time (PT) were measured. Length of stay, and type and number of complications were recorded.Results: Serum IL-6 levels were significantly lower in the steroid group than in the control group 24 h after surgery. Steroid administration significantly modified AST, ALT and PT levels only in patients with chronic liver disease. Overall and lung-related morbidity were not significantly different between the two groups.Conclusions: Steroid administration suppresses serum IL-6 levels, but has no effect on shortterm outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prospective randomized study of steroids in the preventionof ischaemic injury during hepatic resection with pedicle clamping

Muratore

Ribero

Ferrero

et al. 2003

British Journal of Surgery

107

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“…The presence of distant metastasis, main portal vein thrombosis, or inferior vena cava thrombosis is a definite contraindication for resection. Hepatic resection for HCC is associated with a hospital mortality rate of less than 5% in major centers; however, the complication rate remains high, around 30-40% in large series [253][254][255]. Serious complications such as liver failure, postoperative bleeding, and bile leak occur in less than 5% of patients after hepatectomy nowadays [253][254][255].…”

Section: Liver Resectionmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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“…By contrast, evaluation of liver function in patients with cirrhosis is more subtle. Japanese groups rely on Child-Pugh classification coupled with an ICG retention test (Torzilli et al, 1999). In Europe and the US, the best results are obtained in Child-Pugh A patients with the absence of clinically relevant portal hypertension, as reflected by a hepatic venous pressure gradient o10 mm Hg (Bruix et al, 1996).…”

Section: Surgical Resectionmentioning

confidence: 99%

New aspects of diagnosis and therapy of hepatocellular carcinoma

et al. 2006

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Hepatocellular carcinoma is one of the major cancer killers. It affects patients with chronic liver disease who have established cirrhosis, and currently is the most frequent cause of death in these patients. The main risk factors for its development are hepatitis B and C virus infection, alcoholism and aflatoxin intake. If acquistion of risk factors is not prevented and cirrhosis is established, the sole option to improve survival is to detect the tumor at an early stage when effective therapy may be indicated. Early detection plans should be based on hepatic ultrasonography every 6 months, whereas determination of tumor markers is not efficient. Upon detection of a hepatic nodule, there is a need to establish unequivocal diagnosis, either through biopsy or through the application of non-invasive criteria based on the specific radiology appearance of the tumor: fast arterial uptake of contrast followed by venous washout. Effective treatment for liver cancer includes surgical resection, liver transplantation and percutaneous ablation. These options provide a high rate of complete responses and are assumed to improve survival that should exceed 50% at 5 years. If the tumor is diagnosed at an advanced stage, the sole option that improves survival is transarterial chemoembolization. Ongoing research should further advance the time at diagnosis and identify new and effective options targeting molecular pathways governing tumor progression.

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No-Mortality Liver Resection for Hepatocellular Carcinoma in Cirrhotic and Noncirrhotic Patients

Cited by 450 publications

References 65 publications

Prospective randomized study of steroids in the preventionof ischaemic injury during hepatic resection with pedicle clamping

Prospective randomized study of steroids in the preventionof ischaemic injury during hepatic resection with pedicle clamping

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

New aspects of diagnosis and therapy of hepatocellular carcinoma

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