Resection or Transplant in Early Hepatocellular Carcinoma

Schoenberg, Markus Bo; Bucher, Julian Nikolaus; Vater, Adrian; Bazhin, Alexandr V.; Hao, Jihua; Guba, Markus; Angele, Martin K.; Werner, Jens; Rentsch, Markus

doi:10.3238/arztebl.2017.0519

Cited by 24 publications

(27 citation statements)

References 78 publications

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“…Hepatic resection is viewed as the modality of choice for the management of cases of advanced HCC if tissue sparing resection is feasible in patients with CTP A cirrhosis, that is adequate hepatic function . Expectedly, the MELD score will be a poor prognostic factor in this particular group of patients.…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia increases 1‐year mortality after surgical resection of hepatocellular carcinoma

Salman

Omar

Mikhail

et al. 2020

ANZ Journal of Surgery

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Background: Liver resection is a well-recognized modality for hepatocellular carcinoma. Cirrhotic patients are more prone to adverse consequences after liver resection. This work assesses the prognostic significance of sarcopenic hepatocellular carcinoma cases for whom surgical resection was performed. Methods: The present prospective work included 52 cirrhotic cases. Computed tomography scans were used to determine the skeletal muscle index (SMI) at the plane of the third lumbar vertebra (L3). L3 SMI was used for the definition of sarcopenia. The primary outcome measure was the predictive value of sarcopenia for 1-year post-hepatectomy mortality. Results: Sarcopenia was diagnosed in 27 patients (51.9%). All patients had a Child-Turcotte-Pugh score A. At a 1-year follow-up, 20 cases died; that is the 1-year mortality rate was 38.5%. Sarcopenia was more commonly associated with older age and non-viral causes of cirrhosis. The risk of 1-year mortality is 7.6 times higher in sarcopenic patients with a risk ratio of 3.7 (95% confidence interval 1.4-9.6). Conclusion: Sarcopenia diagnosed using L3 SMI is an independent prognostic factor for 1-year deaths in cases with hepatic malignancy with Child-Turcotte-Pugh score A undergoing surgical resection.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 781-785ANZJSurg.com

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Section: Discussionmentioning

confidence: 99%

Sarcopenia increases 1‐year mortality after surgical resection of hepatocellular carcinoma

Salman

Omar

Mikhail

et al. 2020

ANZ Journal of Surgery

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“…2,3 Even in circumstances when a patient is eligible, serious complications can occur in up to 26-33% of procedures. 4 Image-guided interventions are less invasive alternatives to open surgery that focus on relating preoperative data and images of a patient in an intraoperative setting. 5 Smaller surgical incisions often lead to reduced recovery times and complication rates, which directly benefit a patient's quality-oflife and healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

Geometrically variable three‐dimensional ultrasound for mechanically assisted image‐guided therapy of focal liver cancer tumors

et al. 2020

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Purpose Image‐guided focal ablation procedures are first‐line therapy options in the treatment of liver cancer tumors that provide advantageous reductions in patient recovery times and complication rates relative to open surgery. However, extensive physician training is required and image guidance variabilities during freehand therapy applicator placement limit the sufficiency of ablation volumes and the overall potential of these procedures. We propose the use of three‐dimensional ultrasound (3D US) to provide guidance and localization of therapy applicators, augmenting current ablation therapies without the need for specialized procedure suites. We have developed a novel scanning mechanism for geometrically variable 3D US images, a mechanical tracking system, and a needle applicator insertion workflow using a custom needle applicator guide for targeted image‐guided procedures. Methods A three‐motor scanner was designed to use any commercially available US probe to generate accurate, consistent, and geometrically variable 3D US images. The designed scanner was mounted on a counterbalanced stabilizing and mechanical tracking system for determining the US probe orientation, which was assessed using optical tracking. Further exploiting the utility of the motorized scanner, an image‐guidance workflow was developed that moved the probe to any identified target within an acquired 3D US image. The complete 3D US guidance system was used to perform mock targeted interventional procedures on a phantom by selecting a target in a 3D US image, navigating to the target, and performing needle insertion using a custom 3D‐printed needle applicator guide. Registered postinsertion 3D US images and cone‐beam computed tomography (CBCT) images were used to evaluate tip targeting errors when using the motors, tracking system, or mixed navigation approaches. Two 3D US image geometries were investigated to assess the accuracy of a small‐footprint tilt approach and a large field‐of‐view hybrid approach for a total of 48 targeted needle insertions. 3D US image quality was evaluated in a healthy volunteer and compared to a commercially available matrix array US probe. Results A mean positioning error of 1.85 ± 1.33 mm was observed when performing compound joint manipulations with the mechanical tracking system. A combined approach for navigation that incorporated the motorized movement and the in‐plane tracking system corrections performed the best with a mean tip error of 3.77 ± 2.27 mm and 4.27 ± 2.47 mm based on 3D US and CBCT images, respectively. No significant differences were observed between hybrid and tilt image acquisition geometries with all mean registration errors ≤1.2 mm. 3D US volunteer images resulted in clear reconstruction of clinically relevant anatomy. Conclusions A mechanically tracked system with geometrically variable 3D US provides a utility that enables enhanced applicator guidance, placement verification, and improved clinical workflow during focal liver tumor ablation procedures. Evaluations of the tracking accu...

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“…Although liver transplantation and resection are the gold standard curative therapy options for cancer with a 5‐yr survival rate of approximately 40%, these open surgical procedures are often followed by long patient recovery times. Occasionally, serious problems can arise, including organ (graft) rejection, infection, bile duct complications, and immunosuppression‐related issues, leading to a traumatic hospitalization experience for approximately 26% of liver resection patients and 33% of liver transplant patients . In addition, only 10%–20% of patients are candidates for surgery based on strict inclusion criteria including the number and location of tumors, malignant spread of the disease or lymph node involvement, and a range of patient factors (e.g., size, age, and existing medical conditions such as cirrhosis of the liver) .…”

Section: Introductionmentioning

confidence: 99%

“…Occasionally, serious problems can arise, including organ (graft) rejection, infection, bile duct complications, and immunosuppression-related issues, leading to a traumatic hospitalization experience for approximately 26% of liver resection patients and 33% of liver transplant patients. 5 In addition, only 10%-20% of patients are candidates for surgery based on strict inclusion criteria including the number and location of tumors, malignant spread of the disease or lymph node involvement, and a range of patient factors (e.g., size, age, and existing medical conditions such as cirrhosis of the liver). 6,7 Minimally invasive techniques, such as radiofrequency ablation (RFA), microwave ablation (MWA), and irreversible electroporation (IRE), have become alternative therapies for early-stage liver cancer with the most common treatment performed on hepatocellular carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Three‐dimensional therapy needle applicator segmentation for ultrasound‐guided focal liver ablation

et al. 2019

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Purpose Minimally invasive procedures, such as microwave ablation, are becoming first‐line treatment options for early‐stage liver cancer due to lower complication rates and shorter recovery times than conventional surgical techniques. Although these procedures are promising, one reason preventing widespread adoption is inadequate local tumor ablation leading to observations of higher local cancer recurrence compared to conventional procedures. Poor ablation coverage has been associated with two‐dimensional (2D) ultrasound (US) guidance of the therapy needle applicators and has stimulated investigation into the use of three‐dimensional (3D) US imaging for these procedures. We have developed a supervised 3D US needle applicator segmentation algorithm using a single user input to augment the addition of 3D US to the current focal liver tumor ablation workflow with the goals of identifying and improving needle applicator localization efficiency. Methods The algorithm is initialized by creating a spherical search space of line segments around a manually chosen seed point that is selected by a user on the needle applicator visualized in a 3D US image. The most probable trajectory is chosen by maximizing the count and intensity of threshold voxels along a line segment and is filtered using the Otsu method to determine the tip location. Homogeneous tissue mimicking phantom images containing needle applicators were used to optimize the parameters of the algorithm prior to a four‐user investigation on retrospective 3D US images of patients who underwent microwave ablation for liver cancer. Trajectory, axis localization, and tip errors were computed based on comparisons to manual segmentations in 3D US images. Results Segmentation of needle applicators in ten phantom 3D US images was optimized to median (Q1, Q3) trajectory, axis, and tip errors of 2.1 (1.1, 3.6)°, 1.3 (0.8, 2.1) mm, and 1.3 (0.7, 2.5) mm, respectively, with a mean ± SD segmentation computation time of 0.246 ± 0.007 s. Use of the segmentation method with a 16 in vivo 3D US patient dataset resulted in median (Q1, Q3) trajectory, axis, and tip errors of 4.5 (2.4, 5.2)°, 1.9 (1.7, 2.1) mm, and 5.1 (2.2, 5.9) mm based on all users. Conclusions Segmentation of needle applicators in 3D US images during minimally invasive liver cancer therapeutic procedures could provide a utility that enables enhanced needle applicator guidance, placement verification, and improved clinical workflow. A semi‐automated 3D US needle applicator segmentation algorithm used in vivo demonstrated localization of the visualized trajectory and tip with less than 5° and 5.2 mm errors, respectively, in less than 0.31 s. This offers the ability to assess and adjust needle applicator placements intraoperatively to potentially decrease the observed liver cancer recurrence rates associated with current ablation procedures. Although optimized for deep and oblique angle needle applicator insertions, this proposed workflow has the potential to be altered for a variety of image‐guided minimally inva...

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Resection or Transplant in Early Hepatocellular Carcinoma

Cited by 24 publications

References 78 publications

Sarcopenia increases 1‐year mortality after surgical resection of hepatocellular carcinoma

Sarcopenia increases 1‐year mortality after surgical resection of hepatocellular carcinoma

Geometrically variable three‐dimensional ultrasound for mechanically assisted image‐guided therapy of focal liver cancer tumors

Three‐dimensional therapy needle applicator segmentation for ultrasound‐guided focal liver ablation

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