Results of treatment of patients with hepatocellular carcinoma with severe cirrhosis of the liver

Fujio, Nagahisa; Sakai, Katsuji; Kinoshita, Hiroaki; Hirohashi, Kazuhiro; Kubo, Shoji; Iwasa, Ryutaro; Lee, Kwang Choon

doi:10.1007/bf01658403

Cited by 39 publications

(19 citation statements)

References 11 publications

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“…The main purposes of preoperative TACE for resectable HCC are: (1) to improve the detection rate of the other lesions not apparent on pre-TACE radiologic study; (2) to convert initially unresectable tumors to resectable ones, i.e., to induce regression of a huge tumor, enabling safer resection, and (3) to improve long-term results of surgery [11,12,13,14,15]. However, the efficacy of preoperative TACE for resectable HCC is still controversial.…”

Section: Discussionmentioning

confidence: 99%

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Role of Mesohepatectomy with or without Transcatheter Arterial Chemoembolization for Large Centrally Located Hepatocellular Carcinoma

Chen¹,

Zhang³

et al. 2007

Dig Surg

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Background: The role of preoperative transcatheter arterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) was controversial. Methods: 246 patients with large centrally located HCC underwent mesohepatectomy (MH) and were divided into two groups: group A, 89 patients with preoperative TACE; group B, 157 patients without preoperative TACE. The aim was to evaluate the influence of preoperative TACE on postoperative complications and long-term results of patients with large centrally located HCC. Results: In the 89 patients of the TACE-MH group, a total of 123 (mean 1.4 per patient) preoperative TACEs were performed. The differences in postoperative complications (34.8 vs. 24.2%;p = 0.075) and overall hospital mortality (3.4 vs. 0.6%; p = 0.103) between the two groups were not significant. The postoperative recurrence rate in the remnant liver was higher in the MH group than in the TACE-MH group (79.6 vs. 73.0%), while the extrahepatic metastasis rate in the TACE-MH group was higher than that in the MH group (11.1 vs. 7.0%). Overall 1-, 3-, and 5-year survival rates were 87.1, 62.9, and 46.2%, respectively, for the TACE-MH group, and 82.2, 54.4, and 31.7%, respectively, for the MH group (p = 0.001); 1-, 3-, and 5-year disease-free survival rates were 75.0, 46.2, and 31.8%, respectively, for the TACE-MH group, and 69.6, 38.0, and 16.5%, respectively, for the MH group (p = 0.002). Conclusions: Long-term outcomes of patients with preoperative TACE were improved and the pattern of the recurrences after surgery was altered. The patients with large centrally located HCC could benefit more from this neoadjuvant treatment, although there was some influence of preoperative TACE on postoperative complications.

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Section: Discussionmentioning

confidence: 99%

“…TACE was initially used as a palliative therapeutic procedure for unresectable HCC [9, 10] and now, it is frequently performed as a preoperative adjuvant therapy for resectable HCC in some medical centers [11,12,13,14,15]. According to previous studies, however, preoperative TACE has both possible advantages and disadvantages [16,17,18].…”

Section: Introductionmentioning

confidence: 99%

Role of Mesohepatectomy with or without Transcatheter Arterial Chemoembolization for Large Centrally Located Hepatocellular Carcinoma

Chen¹,

Zhang³

et al. 2007

Dig Surg

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“…In patients who underwent PVE, the left liver (nonembolized) volume increased after PVE and liver resection; however, when comparing the volume of the left liver at the beginning of treatment and 4 weeks after surgery, the extent of the volume increase in the left liver in patients who underwent PVE was similar to that in those who did not undergo PVE. This indicated that PVE causes regeneration of the left liver in two stages [6,7].…”

Section: Portal Vein Embolization Before Major Hepatectomymentioning

confidence: 90%

Portal Vein Embolization: History and Current Indications

et al. 2017

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Portal vein embolization (PVE) was first adapted for patients undergoing major hepatectomy for hepatocellular carcinoma (HCC). In these patients, PVE caused hypertrophy of the unaffected liver and increased the volumetric ratio of future liver remnant (FLR) to total liver volume. ^99mTechnetium-galactosyl human serum albumin (^99mTc-GSA) scintigraphy revealed that PVE also induced a shift in hepatic function from the embolized part to the nonembolized part of the liver. Various hepatobiliary malignancies can be treated using PVE, and PVE is increasingly being used to expand the indication for major hepatectomy in patients with initially insufficient FLR volume or function. The indication for PVE is determined by the underlying liver function and standardized FLR volume. In patients with chronic hepatitis, the histologic inflammatory activity was negatively correlated with the increase in FLR volume, and PVE is not suitable for patients with high serum 7s collagen concentrations (>8 ng/ml). This finding may predict the efficacy of PVE. PVE before major hepatectomy can act as a tolerance test to avoid postoperative hepatic failure. PVE also improved long-term survival after liver resection in patients with HCC. Presently, PVE is a safe and useful treatment for patients undergoing major hepatectomy.

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“…Unlike the normal liver, which, within [3][4][5][6][7][8][9][10][11][12] months can regenerate to its original size and function, even after 80% resection, the cirrhotic liver has impaired regenerative ability. Indeed, until recently, the cirrhotic liver was thought to be unable to regenerate [7].…”

Section: Impaired Regenerationmentioning

confidence: 99%

“…In the last 20 [4,5]. Conversely, 10-20% of patients with cirrhosis from any etiology, will go on to develop HCC [3,6].…”

Section: Introductionmentioning

confidence: 99%

Review: Research Toward Safer Resectionof the Cirrhotic Liver

Moser

Kneteman

2000

HPB Surgery

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Despite recent advances in hepatic surgery, resection of the cirrhotic liver continues to be fraught with high morbidity and mortality rates. As a result, for many patients requiring resection of HCC the postoperative course is complicated and the probability of cure is diminished by coexisting cirrhosis. In this review, we discuss the characteristics of the cirrhotic liver which make it poorly tolerant of resection and the most common complications that follow such surgery. The main purpose of this paper is to review recent attempts to identify interventions that might be beneficial to cirrhotic patients undergoing resection. These interventions include assessment of liver reserve, advances in surgical technique, and improvement in liver function and regeneration.

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Results of treatment of patients with hepatocellular carcinoma with severe cirrhosis of the liver

Cited by 39 publications

References 11 publications

Role of Mesohepatectomy with or without Transcatheter Arterial Chemoembolization for Large Centrally Located Hepatocellular Carcinoma

Role of Mesohepatectomy with or without Transcatheter Arterial Chemoembolization for Large Centrally Located Hepatocellular Carcinoma

Portal Vein Embolization: History and Current Indications

Review: Research Toward Safer Resectionof the Cirrhotic Liver

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