Journal of Liver Cancer

Original Articles

Outcomes of liver resection and transarterial chemoembolization in patients with multinodular BCLC-A hepatocellular carcinoma: Jiwon Yang, Won-Mook Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Deok-Bog Moon, Dong-Hwan Jung, Jonggi Choi; J Liver Cancer. 2024;24(2):178-191. Published online April 3, 2024; DOI: https://doi.org/10.17998/jlc.2024.03.25

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Backgrounds/Aims
This study aimed to compare the outcomes of liver resection (LR) and transarterial chemoembolization (TACE) in patients with multinodular hepatocellular carcinoma (HCC) within the Milan criteria who were not eligible for liver transplantation.
Methods
We retrospectively analyzed 483 patients with multinodular HCC within the Milan criteria, who underwent either LR or TACE as an initial therapy between 2013 and 2022. The overall survival (OS) in the entire population and recurrence-free survival (RFS) in patients who underwent LR and TACE and achieved a complete response were analyzed. Propensity score (PS) matching analysis was also used for a fair comparison of outcomes between the two groups.
Results
Among the 483 patients, 107 (22.2%) and 376 (77.8%) underwent LR and TACE, respectively. The median size of the largest tumor was 2.0 cm, and 72.3% of the patients had two HCC lesions. The median OS and RFS were significantly longer in the LR group than in the TACE group (P<0.01 for both). In the multivariate analysis, TACE (adjusted hazard ratio [aHR], 1.81 and aHR, 2.41) and large tumor size (aHR, 1.43 and aHR, 1.44) were significantly associated with worse OS and RFS, respectively. The PS-matched analysis also demonstrated that the LR group had significantly longer OS and RFS than the TACE group (PS<0.05).
Conclusions
In this study, LR showed better OS and RFS than TACE in patients with multinodular Barcelona Clinic Liver Cancer stage A HCC. Therefore, LR can be considered an effective treatment option for these patients.

Citations

Citations to this article as recorded by

Survival Prediction and Treatment Decisions in Hepatocellular Carcinoma: A Deep Learning-Based Radiomics Approach
Xiaoqin Wei, Jun Xiao, Ying Liu, Chaofeng Yang, Ziren Luo, Mingyue Tang, Xiaowen Chen
British Journal of Hospital Medicine.2026;[Epub] CrossRef
A Prospective, Multicenter, Randomized, Noninferiority Trial of Stopad® Versus Tachosil® for Hemostasis After Liver Resection
Seung Yeon Lim, Gi Hong Choi, Jin Hong Lim, Ho-Seong Han, Yoo-Seok Yoon, Hae Won Lee, Boram Lee, Yeshong Park, MeeYoung Kang, Jinju Kim, Hyelim Joo, Jai Young Cho
Cancers.2025; 17(5): 757. CrossRef
Comparison of initial treatments for resectable hepatocellular carcinoma within Milan criteria: an observational study based on a nationwide survey
Sang Jin Kim, Woo Kyoung Jeong, Hyung-Joon Han, Gyu-Seong Choi, Kyun-Hwan Kim, Jongman Kim
Annals of Surgical Treatment and Research.2025; 108(5): 279. CrossRef
Comparative analysis of the immediate results of surgical treatment in patients with early (BCLC A) and intermediate (BCLC B) stage hepatocellular carcinoma
B. I. Sakibov, D. V. Podluzhnyi, Yu. I. Patyutko, E. A. Moroz, O. A. Egenov, N. E. Kudashkin
Surgery and Oncology.2025; 15(2): 52. CrossRef
Artificial intelligence for multi-time-point arterial phase contrast-enhanced MRI profiling to predict prognosis after transarterial chemoembolization in hepatocellular carcinoma
Lanlin Yao, Hamzah Adwan, Simon Bernatz, Hao Li, Thomas J. Vogl
La radiologia medica.2025; 130(10): 1517. CrossRef
Exploring the role of liver resection as a first-line treatment option for multinodular BCLC-A hepatocellular carcinoma
Joo Hyun Oh, Dong Hyun Sinn
Journal of Liver Cancer.2024; 24(2): 126. CrossRef

Indications for open hepatectomy in the era of laparoscopic liver resection: a high volume single institutional study: Sung Jun Jo, Jinsoo Rhu, Jong Man Kim, Gyu-Seong Choi, Jae-Won Joh; J Liver Cancer. 2022;22(2):146-157. Published online September 14, 2022; DOI: https://doi.org/10.17998/jlc.2022.08.22

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5 Citations

Abstract PDF Supplementary Material

Background/Aim
Since the introduction of laparoscopy for liver resection in the 1990s, the performance of laparoscopic liver resection (LLR) has been steadily increasing. However, there is currently no data on the extent to which laparoscopy is used for liver resection. Herein, we investigated the extent to which laparoscopy is performed in liver resection and sought to determine whether surgeons prefer laparoscopy or laparotomy in the posterosuperior (PS) segment.
Methods
For this retrospective observational study, we enrolled patients who had undergone liver resection at the Samsung Medical Center between January 2020 and December 2021. The proportion of LLR in liver resection was calculated, and the incidence and causes of open conversion were investigated.
Results
A total of 1,095 patients were included in this study. LLR accounted for 79% of the total liver resections. The percentage of previous hepatectomy (16.2% vs. 5.9%, P<0.001) and maximum tumor size (median 4.8 vs. 2.8, P<0.001) were higher in the open liver resection (OLR) group. Subgroup analysis revealed that tumor size (median 6.3 vs. 2.9, P<0.001) and surgical extent (P<0.001) in the OLR group were larger than those in the LLR group. The most common cause of open conversion (OC) was adhesion (57%), and all OC patients had tumors in the PS.
Conclusions
We investigated the recent preference of practical surgeons in liver resection, and found that surgeons preferred OLR to LLR when treating a large tumor located in the PS.

Citations

Citations to this article as recorded by

Effects of Ultrasound-Guided Oblique Subcostal Transversus Abdominis Block Combined With Patient-Controlled Intravenous Analgesia on Analgesia and Early Recovery After Open Hepatectomy
Chao Wang, Wenwen Xu, Youpei Li, Yu Sun, Weiqing Chen, Wei Yang, Ke An
The Clinical Journal of Pain.2026;[Epub] CrossRef
STUDY PROTOCOL FOR A DUAL-CENTER RANDOMIZED CONTROLLED TRIAL COMPARING LAPAROSCOPIC AND OPEN ‘MINOR’ LIVER RESECTIONS IN UKRAINIAN COLORECTAL CANCER PATIENTS WITH LIVER METASTASES
A. BURLAKA, S. ZEMSKOV, V. BEZVERKHNYI, A. BEZNOSENKO
Experimental Oncology.2025; 47(1): 115. CrossRef
Radiofrequency Ablation versus Surgical Resection in Elderly Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
Jeong-Ju Yoo, Sujin Koo, Gi Hong Choi, Min Woo Lee, Seungeun Ryoo, Jungeun Park, Dong Ah Park
Current Oncology.2024; 31(1): 324. CrossRef
Efficacy and Safety of Surgical Resection in Elderly Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
Jin-Soo Lee, Dong Ah Park, Seungeun Ryoo, Jungeun Park, Gi Hong Choi, Jeong-Ju Yoo
Gut and Liver.2024; 18(4): 695. CrossRef
A systematic review and meta-analysis of blood transfusion rates during liver resection by country
Seonju Kim, Yun Kyung Jung, Kyeong Geun Lee, Kyeong Sik Kim, Hanjun Kim, Dongho Choi, Sumi Lee, Boyoung Park
Annals of Surgical Treatment and Research.2023; 105(6): 404. CrossRef

Case Report

A Case of Unresectable Hepatocellular Carcinoma Treated by Repeated Transcatheter Arterial Chemoembolization Using DC beads® Followed with Resection: Jeong-Yeop Song, Young Seok Kim, Jae Myeong Lee, Soo Ji Jin, Kyu Sung Choi, Yun Nah Lee, Sang Hyune Kim, Sung Won Jeong, Jae Young Jang, Sae Hwan Lee, Hong Soo Kim, Boo Sung Kim; Journal of the Korean Liver Cancer Study Group. 2013;13(1):65-69. Published online February 28, 2013; DOI: https://doi.org/10.17998/jlc.13.1.65

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Abstract PDF: In patients with unresectable hepatocellular carcinoma (HCC) and no anti-cancer treatment, the prognosis is quite poor. But in some cases, repeated sessions of transcatheter arterial chemoembolization (TACE) reduce the tumor size even to resectable, and post-TACE resection may prolong the survival time. We present a case of 50-year-old HBV carrier woman with abdominal distension. The diagnosis was huge HCC with intrahepatic metastasis. Repeated intra-arterial injections of adriamycin mixed lipiodol or DC beads® (100-300/300-500/500-700 μm, ©BIOCOMPATIBLES UK LTD) were instituted through ten sessions for 13 months. The tumor size became reduced with a partial response after 10th TACE and post-TACE resection was performed. No visible HCCs and decreased tumor markers were noted on the examinations 3 months after the resection.

Review Article

Strategies for the Curative Therapy of Early Stage HCC: First or SalvageTransplantation?: Nam-Joon Yi; Journal of the Korean Liver Cancer Study Group. 2012;12(2):102-108. Published online September 30, 2012

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Abstract PDF: Hepatocellular carcinoma (HCC) is a major cause of cancer mortality worldwide, especially in Asian countriesas well as Korea, and liver transplantation (LT) has potentials to improve survival for patients with HCC. However, major hamper to LT for HCC has been graft shortage. To solve this problem, liver resection (LR) has to be rejuvenated in the general algorithm of HCC treatment in the light of salvage transplantation (ST) strategies. The LR followed by ST in case of HCC recurrence is an attractive concept in early stage HCC and cirrhosis with acceptable liver function. These challenges in technique, indications, pre-LT observation and treatments for recurred HCC, and prioritization policies of patients on the waiting list have to be precise through prospective investigations that have to include individualization of prognosis, biological variables and pathology surrogates as stratification criteria. Accepting this challenges have been part of the history of LT and will endure for the future. This article will focus on the ST after LR in terms of intention-to-analysis

Case Reports

A Case of Emergent Treatment for Hemodynamic Unstable Patient with Ruptured Hepatocellular Carcinoma: Jae Keun Kim, Joon Seong Park, Ja Kyung Kim, Hyo Jun Lee, Kwang Hoon Lee, Kwan Sik Lee, Dong Sup Yoon; Journal of the Korean Liver Cancer Study Group. 2012;12(2):160-163. Published online September 30, 2012

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Abstract PDF: A ruptured Hepatocellular carcinoma (HCC) is one of life threatening complication and considered as poor prognosis. Hemodynamic stability is a key to the early period survival. Hemostasis can be achieved with transarterial embolization and explo‐laparotomy or surgical resection. Prognosis is related to hemodynamic stability and liver function and tumor size. Surgical resection of ruptured HCC is recommended when it is possible. Further studies are needed for the treatment of recurred and progressive patients with ruptured HCC.

A Case of Early and Massive Recurred Hepatocellular Carcinoma in Patients with Ruptured Hepatocellular Carcinoma Underwent Staged-Surgical Resection: Sung Hoon Kim, Jin Hong Lim, Sang Hoon Ahn, Kyung Sik Kim; Journal of the Korean Liver Cancer Study Group. 2011;11(2):155-159. Published online September 30, 2011

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2 Downloads

Abstract PDF: The rupture of hepatocellular carcinoma (HCC) has been uncommon complication. Because the diagnosis of early HCC has been increase due to development of imaging modality and surveillance program, the incidence of ruptured HCC has been decreased. The paradigm of treatment for ruptured HCC has shifted from surgical hemostasis to transcatheteric chemoembolization (TACE) at acute phase. After the control of acute phase, the definitive treatment for HCC is still debate. However, many studies have advocated staged-liver resection. Some studies reported that the patients underwent staged-liver resection showed a similar survival rate compared with survival rate in patient with non-ruptured HCC. The staged-liver resection was usually performed in the patients with well-preserved liver function. The decision of optimal time for surgery after TACE and surgical indications for ruptured HCC after any other primary treatment are controversy. We experienced a cases of early and massive recurrence HCC in patients with well-preserved liver function and the rupture of HCC. The further study may be needed to decide the optimal time of surgery after TACE and surgical indication for rutprued-HCC.

Review Article

Analysis of 38 Long-Term Survivors after Liver Resections for Hepatocellular Carcinoma: Seong Woo Hong , Hyuck Sang Lee, Yang Won Nah; Journal of the Korean Liver Cancer Study Group. 2001;1(1):12-19. Published online June 30, 2001

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Abstract PDF: Background/Aims
This study was conducted to develop an optimal strategy to achieve a long-term survival after liver resection for hepatocellular carcinoma. Methods: Between July 1975 and March 1995, 109 patients who underwent liver resection for hepatocellular carcinoma at Inje University Seoul Paik Hospital were analyzed retrospectively. Results: Thirty-eight patients (34.9%) survived longer than 5 years after operation. Prognostic factors of statistical significance were the diagnostic clue, ICG R15, TNM stage, extent of tumor, intrahepatic metastasis, portal vein thrombosis, serosal interval. For 63 cases with no intrahepatic metastasis, there was no survival difference between the lobectomy group and the segmentectomy/subsegmentectomy group (36.8% vs. 50.0%). In the subset of patients with satellite nodules confined to one single segment of the liver, 66.7% of the those who underwent lobectomy lived longer than 5 years while only 17.6% of the patients who had a lesser resection survived long-term(p=0.025). Conclusion: For the achievement of a long-term survival in patients with hepatocellular carcinoma, a systematic segmentectomy/subsegmentectomy is adequate for those with no intrahepatic metastasis, while the presence of satellite nodules in one segment calls for a standard hepatic lobectomy.

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