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.
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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
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.
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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
Background/Aims Multiplication of α-fetoprotein, des-γ-carboxy prothrombin, and tumor volume (ADV score) is a surrogate marker for post-resection prognosis of hepatocellular carcinoma (HCC). This study aimed to validate the predictive power of the ADV score-based prognostic prediction model for patients with solitary huge HCC.
Methods Of 3,018 patients, 100 patients who underwent hepatic resection for solitary HCC ≥13 cm between 2008 and 2012 were selected.
Results The median tumor diameter and tumor volume were 15.0 cm and 886 mL, respectively. Tumor recurrence and overall survival (OS) rates were 70.7% and 66.0% at one year and 84.9% and 34.0% at five years, respectively. Microvascular invasion (MVI) was the only independent risk factor for disease-free survival (DFS) and OS. DFS and OS, stratified by ADV score with 1-log intervals, showed significant prognostic contrasts (P=0.007 and P=0.017, respectively). DFS and OS, stratified by ADV score with a cut-off of 8-log, showed significant prognostic contrasts (P=0.014 and P=0.042, respectively). The combination of MVI and ADV score with a cut-off of 8-log also showed significant prognostic contrasts in DFS (P<0.001) and OS (P=0.001) considering the number of risk factors. Prognostic contrast was enhanced after combining the MVI and ADV score.
Conclusions The prognostic prediction model with the ADV score could reliably predict the risk of tumor recurrence and long-term patient survival outcomes in patients with solitary huge HCCs ≥13 cm. The results of this study suggest that our prognostic prediction models can be used to guide surgical treatment and post-resection follow-up for patients with huge HCCs.
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Background/Aims To investigative the potential role of postoperative chemoradiotherapy (CCRT) after R1 resection of intrahepatic cholangiocarcinoma (IHCC). Methods Between January 2000 and December 2012, medical records of 18 patients who underwent curative surgery with R1 resection for IHCC were retrospectively reviewed. Results Median age was 68 years and 12 patients (66.7%) were male. Median tumor size was 5.0 cm (range, 2.2-11.0) and 12 patients (66.7%) had T3 or higher disease. Lymph nodes were involved in four patients (22.2%). Vascular invasion and perineural invasion were present in 10
(55.6%) and 12 patients (66.7%), respectively. Postoperative CCRT given with 5-fluorouracil or gemcitabine were delivered to 7 patients (38.9%). Median radiation dose was 50.4 Gy (range, 45-54). Univariate analysis showed that median loco-regional recurrence-free survival (LRRFS), progression-free survival (PFS) and overall survival (OS) were prolonged for patients treated with CCRT (median LRRFS; 5.6 months vs. not reached, P<0.001, median PFS; 5.6 vs. 8.3 months,
P=0.047, median OS; 15.0 vs. 26.6 months, P=0.064). Conclusions Postoperative CCRT improved the loco-regional control and PFS in IHCC patients with R1 resection. Further study is warranted to validate the role of postoperative CCRT for these patients.
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Precision therapy for intrahepatic cholangiocarcinoma: A case report on adjuvant treatment in a recurrent patient after surgery and literature review Bao Ying, Tao Tang, Li-Xing Zhang, Jian-Wei Xiong, Kai-Feng Zhao, Jia-Wei Li, Guo Wu Oncology Letters.2023;[Epub] CrossRef
Stereotactic radiotherapy for intrahepatic cholangiocarcinoma Aditya Borakati, Farid Froghi, Ricky H Bhogal, Vasileios K Mavroeidis World Journal of Gastrointestinal Oncology.2022; 14(8): 1478. CrossRef
Background/Aims Many recent studies have shown excellent outcomes of surgical resection
for ruptured hepatocellular carcinoma (HCC). In addition, there are several reports suggesting
that a ruptured HCC did not increase the risk for peritoneal dissemination of a tumor after
surgical resection. However, the impact of HCC rupture on recurrence and patient survival has
not yet been clarified.
Methods The medical data of patients who underwent surgical resection for ruptured HCC
in our center between January 2011 and December 2015 were retrospectively reviewed. The
outcomes of the patients were investigated.
Results Among 128 patients who underwent surgical resection for HCC, 5 patients (3.9%) had
a ruptured HCC. All patients underwent elective operation in a stable condition. Transarterial
chemoembolization (TACE) was performed for achieving hemostasis in four patients except
one who achieved spontaneous hemostasis. Two patients had tumor recurrence and one
patient died due to HCC recurrence during the median follow-up duration of 28.3 months
(range, 24.3–62.3 months). One patient who developed late intrahepatic recurrence at 40.0
months after resection was managed well by means of radiofrequency ablation and TACE and
is now alive for 5 years without any evidence of viable tumor. However, the other patient who
showed early peritoneal seeding at 1.9 months after resection finally died despite aggressive
treatments.
Conclusions Rupture of HCC might result in peritoneal seeding of the tumor in the early
postoperative stage, which could lead to a poor result. Nonetheless, surgical resection may be
the best treatment option yielding good survival, even for a ruptured HCC.
Citations
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Ruptured Massive Hepatocellular Carcinoma Cured by Transarterial Chemoembolization Ji Eun Lee, Joong-Won Park, In Joon Lee, Bo Hyun Kim, Seoung Hoon Kim, Hyun Beom Kim Journal of Liver Cancer.2020; 20(2): 154. CrossRef
Hepatocellular carcinoma (HCC) is one of the cancers with poor prognosis. However, surgical
resection is the treatment of choice as curative aim for early HCC with preserved liver function.
A 5 year survival rate after curative resection is over 50%. We experienced a case of rapidly
recurred HCC with bone metastasis after surgical resection. In our case, microscopically
microvessel invasion was present after resection. Microvascular invasion (MVI) is an important
factor to influence survival and/or HCC recurrence. So we suggested the patients with MVI
need to follow up intensively and adjuvant therapy may be considered.
Kyung Woo Park, Young Seok Kim, Sang Gyune Kim, Soung Won Jeong, Jae Young Jang, Hong Soo Kim, Sae Hwan Lee, Boo Sung Kim, Jun Cheol Jeong, Min Hee Lee, Jae Myeong Lee, Hee Kyung Kim
J Liver Cancer. 2015;15(2):122-125. Published online September 30, 2015
For a small hepatocellular carcinoma (HCC), liver resection shows most favorable outcome in case which liver transplantation is not available, although it has also substantial recurrence
rate. Here, we report a case of recurred HCC with multiple intrahepatic metastasis at 5 months
after surgical resection for small HCC was done. A 55-year-old man with chronic HBV infection
received subsegmentectomy for HCC less than 2 cm. A follow-up computed tomography (CT)
at 5 months from operation revealed that there were multiple enhancing nodules in entire
remnant liver. Intra-arterial injections of adriamycin mixed lipiodol and gelfoam particles were
instituted through hepatic artery. We assume that poorly differentiated cellular feature would
be attributable to this kind of very early and aggressive recurrence of HCC. (J Liver Cancer
2015;15:122-125)
Hepatocellular carcinoma (HCC) have relatively well known causative factors such as chronic
hepatitis B, chronic hepatitis C, alcoholic liver disease, Non-alcoholic fatty liver disease (NAFLD),
liver cirrhosis and so on. Recently, interesting reports that HCC in the absence of cirrhosis
or other chronic liver disease and HCC associated with NAFLD and metabolic syndrome are
increasing in USA. So far, there is no report about these issues in Korea. We present a 65 yearold
obesity male who had no preceding chronic liver disease history. He was diagnosed as
primary HCC and the mass was removed completely. However, HCC recurred shortly after
operation. Multiple recurred HCC were treated with transcatheter arterial chemoembolization.
(J Liver Cancer 2015;15:112-117)
Although surgical resection can provide best treatment outcome with curative intent,
patients with relatively early stage of hepatocellular carcinoma (HCC) can get benefit of this
treatment. Barcelona Clinic Liver Cancer (BCLC) staging system limits surgical resection to
patients with single HCC with well-preserved liver function, which is often challenged in real
practice, especially from Asian countries. During last two decades, surgical outcomes have
made remarkable progress approaching zero mortality in many reports. In this review, areas
that surgical indications can be expanded beyond BCLC staging system will be discussed,
especially in Asian population. (Journal of Liver Cancer 2015;15:1-3)
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
Early stage HCC has generally been defined as the “Milan criteria”: a solitary tumor ≤ 5 cm in size, or ≤ 3 tumors each ≤ 3 cm
in size and no evidence of gross vascular invasion. HCC is now increasingly detected at earlier stages. In addition, both liver
transplantation and percutaneous ablative therapies have emerged as effective alternatives to hepatic resection. As a result, the
ideal treatment strategy for patients with early stage HCC, particularly in the setting of well-preserved hepatic function, has
become increasingly controversial. In the recent studies, the survival rates for transplantation in early stage HCC patients are
excellent. However, when intention-to-treat analysis is used, dropouts from the waiting list due to death or disease progression
clearly diminish long-term survival results and therefore patients are unlikely to benefit from liver transplantation. In addition,
salvage transplantation after HCC resection may be performed without excessive morbidity and may result in equivalent survival
rates compared with primary liver transplantation. In some studies, salvage transplantation may be feasible in up to 75-80% of
patients with recurrence following hepatic resection. Similarly, locoregional therapies serve to sustain patients with HCC on the
waiting list until a transplantation become available. While RFA and TACE are commonly used to prevent dropout, pretransplant
therapy has not been associated with improved overall survival or disease-free survival due to persistenceof viable tumor. It is
important to note that, while resection is a more invasive procedure, the benefit that it holds over nonresectional therapies is the
complete removal of the tumor allowing for subsequent detailed pathologic examination of both the tumor and surrounding liver
parenchyma. In conclusion, in patients with well-preserved hepatic function, liver resection remains the most appropriate and
effective treatment.
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
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.
Bun Kim, Jae Hoon Min, Seung Up Kim, Jun Yong Park, Kwang Hoon Lee, Do Youn Lee, Jin Sub Choi, Young Deuk Choi, Nam Hoon Cho, Young Nyun Park, Sang Hoon Ahn, Kwang Hyub Han, Chae Yoon Chon, Do Young Kim
Journal of the Korean Liver Cancer Study Group. 2012;12(1):51-57. Published online February 28, 2012
Advanced hepatocellular carcinoma (HCC) is difficult to treat and the survival is poor. Here, we present a patient diagnosed as
advanced HCC (stage IIIa) which was supervening with early renal cell cancer (stage I). The patient was treated with
pre-operational transarterial chemoembolization (TACE) and surgical resection (right hepatectomy, right nephrectomy, and
cholecystectomy). Sorafenib were taken continually after surgery. Multiple recurred HCC nodules in remnant liver were detected
2 months later after surgery. Combined treatment modalities including 4 sessions of TACE, and 12 cycles of 5-flurouracil
(FU)/carboplatin based hepatic arterial infusional chemotherapy (HAIC) induced complete response. After the diagnosis of
advanced HCC, the patient survived 36 months and experienced disease-free status for 19 months.
Sun Jae Lee, Hyung Joon Yim, Hwan Hoon Chung, Hae Rim Kim, Eileen L. Yoon, Jong Jin Hyun, Sung Woo Jung, Ja Seol Koo, Rok Son Choung, Sang Woo Lee, Jai Hyun Choi
Journal of the Korean Liver Cancer Study Group. 2012;12(1):67-70. Published online February 28, 2012
35-year-old female patient was diagnosed with hepatocellular carcinoma and underwent hepatic resection. 12 months after
hepatic resection, serum AFP rose (119.6 ng/mL) but no definite recurrence was found on imaging modalities. 30 months after
hepatic resection, serum AFP rose up to 1008.5 ng/mL and metastatic nodule was found in right lower lung in chest CT. Video
assisted thoracoscopic wedge resection was performed and 400 mg/day of sorafenib was intiated. Serum AFP returned to normal
range after 2 months of pulmonary resection. No evidence of recurrence is noted after 30 months of pulmonary resection. We
think that pulmonary resection plus sorafenib combination therapy resulted in favorable treatment outcome in this patient.