Role of a hepatectomy for the treatment of large hepatocellular carcinomas measuring 10 cm or larger in diameter

Shimada, Kazuaki; Sakamoto, Yoshihiro; Esaki, Minoru; Kosuge, Tomoo

doi:10.1007/s00423-007-0264-4

Cited by 21 publications

(30 citation statements)

References 19 publications

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“…In these studies, noncurative resection was strongly associated with multiple tumors with portal vein thrombus. A survival benefit can be obtained only when the tumor does not have macroscopic tumor thrombus [28]. However, the histopathological detection of tumor at the surgical cut edge indicates recurrence at the section margin.…”

Section: Resultsmentioning

confidence: 99%

Surgery for Intermediate and Advanced Hepatocellular Carcinoma: A Consensus Report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014)

Hasegawa

Chen

et al. 2016

Liver Cancer

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Background: The Barcelona Clinic Liver Cancer (BCLC) staging and treatment strategy does not recommended surgery for treating BCLC stage B and C hepatocellular carcinoma (HCC). However, numerous Asia-Pacific institutes still perform surgery for this patient group. This consensus report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting aimed to share opinions and experiences pertaining to liver resection for intermediate and advanced HCCs and to provide evidence to issue recommendations for surgery in this patient group. Summary: Thirteen experts from five Asia-Pacific regions were invited to the meeting; 10 of them (Japan: 2, Taiwan: 3, South Korea: 2, Hong Kong: 1, and China: 2) voted for the final consensus. The discussion focused on evaluating the preoperative liver functional reserve and surgery for large tumors, multiple tumors, HCCs with vascular invasion, and HCCs with distant metastasis. The feasibility of future prospective randomized trials comparing surgery with transarterial chemoembolization for intermediate HCC and with sorafenib for advanced HCC was also discussed. The Child-Pugh score (9/10 experts) and indocyanine green retention rate at 15 min (8/10) were the most widely accepted methods for evaluating the preoperative liver functional reserve. All (10/10) experts agreed that portal hypertension, tumor size >5 cm, portal venous invasion, hepatic venous invasion, and extrahepatic metastasis are not absolute contraindications for the surgical resection of HCC. Furthermore, 9 of the 10 experts agreed that tumor resection may be performed for patients with >3 tumors. The limitations of surgery are associated with a poor liver functional reserve, incomplete tumor resection, and a high probability of recurrence. Key Messages: Surgery provides significant survival benefits for Asian-Pacific patients with intermediate and advanced HCCs, particularly when the liver functional reserve is favorable. However, prospective randomized controlled trials are difficult to conduct because of technical and ethical considerations.

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Section: Resultsmentioning

confidence: 99%

Surgery for Intermediate and Advanced Hepatocellular Carcinoma: A Consensus Report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014)

Hasegawa

Chen

et al. 2016

Liver Cancer

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“…Six studies had more than 100 patients [10,11,13,17,24,25], 4 studies had from 50 to 100 patients [12,19,27,29], and the remaining 11 studies had fewer than 50 patients [6–9,15,22,23,26,28,30,31]. …”

Section: Quantity Of Evidencementioning

confidence: 99%

Safety and efficacy of partial hepatectomy for huge (≥10 cm) hepatocellular carcinoma: A systematic review

Zhou

et al. 2011

Med Sci Monit

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SummaryHuge (≥10 cm) hepatocellular carcinoma (HCC) is not uncommon at clinical presentation, and the surgical outcomes of such tumors are poor. This systematic review aimed to assess the safety and efficacy of partial hepatectomy for huge HCC.We performed a search on Medline and PubMed databases for all relevant studies published prior to December 2009. After exclusions, 21 studies remained for appraisal and data extraction.All studies were classified as level-4 evidence. The median overall perioperative morbidity and mortality rates were 29.2% (range: 13.6–72%) and 3.5% (range: 0–18.2%), respectively. The overall median survival since the partial hepatectomy was 20.7 months (range: 10.1–32 months), with median 1-, 3- and 5-year survival of 60.7% (range: 41–72.2%), 34% (range: 0–60.3%) and 28.6% (range: 0–54%), respectively. The median disease-free survival since the partial hepatectomy was 11.3 months (range: 5.5–32months), with median 1-, 3- and 5-year disease-free survival rates of 48.7% (range: 32–65.4%), 27.5% (range: 14.1–49%) and 20.7% (range: 9.5–43%), respectively.Partial hepatectomy can be performed safely and is associated with long-term survival in a subset of patients with huge HCC, but the evidence of benefit is currently weak.

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“…Liver resection is a common abdominal operation with high risk of postoperative morbidity and mortality [10–13]. Data on the implementation of a fast-track clinical pathway in liver surgery are sparse [14, 15].…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Fast-Track Clinical Pathway Decreases Postoperative Length of Stay and Hospital Charges for Liver Resection

Lin¹,

et al. 2011

Cell Biochem Biophys

104

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A fast-track clinical pathway is designed to streamline patient care delivery and maximize cost effectiveness. It has decreased postoperative length of stay (LOS) and hospital charges for many surgical procedures. However, data on clinical pathways after liver surgery are sparse. This study examined whether use of a fast-track clinical pathway for patients undergoing elective liver resection affected postoperative LOS and hospital charges. A fast-track clinical pathway was developed and implemented by a multidisciplinary team for patients undergoing liver resection. Between July, 2007 and May, 2008, a total of 117 patients underwent elective liver resection: the fast-track clinical pathway (education of patients and families, earlier oral feeding, earlier discontinuation of intravenous fluid, no drains or nasogastric tubes, early ambulation, use of a urinary catheter for less than 24 h and planned discharge 6 days after surgery) was studied prospectively in 56 patients (postpathway group). These patients were compared with the remainder who had usual care (prepathway group). Outcome measures were postoperative LOS, perioperative hospital charges, intraoperative and postoperative complications, mortality, and readmission rate. Among all patients, 69 (59%) had complicating diseases and/or a history of surgery and 24 patients belonged to American Society of Anesthesiologists grade III–IV. Compared with the prepathway group, the postpathway group had a significantly shorter postoperative LOS (7 vs. 11 days, P < 0.01). The average perioperative hospital charges were RMB 26,626 for patients in the prepathway group and only RMB 21,004 for those in the postpathway group (P < 0.05), with no differences in intraoperative and postoperative complications (P = 0.814), mortality (P = 0.606), and readmission rate (P = 0.424). Implementation of the fast-track clinical pathway is an effective and safe method for reducing postoperative LOS and hospital charges for high-risk patients undergoing elective liver resection. The result supports the further development of fast-track clinical pathways for liver surgical procedures.

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Role of a hepatectomy for the treatment of large hepatocellular carcinomas measuring 10 cm or larger in diameter

Cited by 21 publications

References 19 publications

Surgery for Intermediate and Advanced Hepatocellular Carcinoma: A Consensus Report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014)

Surgery for Intermediate and Advanced Hepatocellular Carcinoma: A Consensus Report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014)

Safety and efficacy of partial hepatectomy for huge (≥10 cm) hepatocellular carcinoma: A systematic review

Implementation of a Fast-Track Clinical Pathway Decreases Postoperative Length of Stay and Hospital Charges for Liver Resection

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