Surgical Therapy of Hepatocellular Carcinoma in the Cirrhotic Liver

Hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis was considered by some surgeons contraindicated because the hospital mortality rate, especially for major hepatectomy, was very high. The author reported his surgical approach to hepatectomy associated with cirrhosis. Between 1989 and 1995, 66 major hepatectomies and 32 minor hepatectomies were performed in 98 cirrhotic patients. The selection of patients for hepatectomy was based on results of indocyanine green clearance test. The surgical technique was designed to reduce blood loss, ischaemic injury to the liver remnant and preservation of liver parenchyma. The postoperative care was designed to maintain or improve liver function. By such an approach, the hospital mortality rate of the cirrhotic patients having hepatectomy decreased from 40% in 1989 to 5% in 1995. The 5-year survival rate also improved to 41.2%, which is not statistically different from that of those with a normal liver or chronic hepatitis. With refinement in surgical technique and perioperative care, patients with cirrhosis can also benefit from hepatectomy for HCC.

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ICG Clearance in Assessing Cirrhotic Patients with Hepatocellular Carcinoma for Major Hepatic Resection

HPB Surgery ◽

10.1155/1997/69231 ◽

1997 ◽

Vol 10 (3) ◽

pp. 182-183 ◽

Cited By ~ 9

Author(s):

Seigo Kitano ◽

Yang-II Kim

Keyword(s):

Hepatocellular Carcinoma ◽

Mortality Rate ◽

Blood Loss ◽

Hospital Mortality ◽

Chronic Active Hepatitis ◽

Major Hepatectomy ◽

Selection Criterion ◽

Tertiary Referral Center ◽

Icg Clearance ◽

Cirrhotic Patients

Objective: To deWne the safety of major hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis and the selection criteria for surgery in terms of hospital mortality.Design: Major hepatectomy for HCC in the presence of cirrhosis is considered to be contraindicated by many surgeons because the reported mortality rate is high (26% to 50%). Previous workers recommended that only selected patients with Child's A status or indocyanine green (ICG) retention at 15 minutes of less than 10% undergo major hepatectomy. A survery was made, therefore, of our patients with HCC and cirrhosis undergoing major hepatectomy between 1989 and 1994.Setting: A tertiary referral center.Patients: The preoperative, intraoperative, and post-operative data of 54 patients with cirrhosis who had major hepatectomy were compared with those of 25 patients with underlying chronic active hepatitis and 22 patients with normal livers undergoing major hepatectomy for HCC. The data had been prospectively collected.Intervention: Major hepatectomy, defined as resection of two or more liver segments by Goldsmith and Woodburn nomenclature, was performed on all the patients. Main Outcome Measure: Hospital mortality, which was defined as death within the same hospital admission for the hepatectomy.Results: Preoperative liver function in patients with cirrhosis was worse than in those with normal livers. The intraoperative blood loss was also higher (P=.01), but for patients with cirrhosis, chronic active hepatitis, and normal livers, the hospital mortality rates (13%, 16%, and 14%, respectively) were similar. The hospital mortality rate for patients with cirrhosis in the last 2 years of the study was only 5%. Patients with cirrhosis could tolerate up to 10 L of blood loss and survive the major hepatectomy. By discriminant analysis, an ICG retention of 14% at 15 minutes was cutoff level that could maximally separate the patients with cirrhosis with and without mortality.Conclusion: Major hepatectomy for HCC in the presence of cirrhosis is associated with a mortality rate that is not different from the rate for patients with normal livers. An ICG retention of 14% at 15 minutes would serve as a better selection criterion than the 10% previously used.

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In-hospital mortality associated with transcatheter arterial embolization for treatment of hepatocellular carcinoma in patients on hemodialysis for end stage renal disease: a matched-pair cohort study using a nationwide database

BJR|Open ◽

10.1259/bjro.20190004 ◽

2019 ◽

Vol 1 (1) ◽

pp. 20190004

Author(s):

Masaya Sato ◽

Ryosuke Tateishi ◽

Hideo Yasunaga ◽

Hiroki Matsui ◽

Kiyohide Fushimi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Mortality Rate ◽

Hospital Mortality ◽

End Stage Renal Disease ◽

Odds Ratio ◽

Matched Pair ◽

Complication Rates ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Objectives: No previous study has evaluated the risks associated with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma in patients on hemodialysis (HD) for end stage renal disease (ESRD), because invasive treatment is rarely performed for such patients. We used a nationwide database to investigate in-hospital mortality and complication rates following TACE in patients on HD for ESRD. Methods: Using the Japanese Diagnosis Procedure Combination database, we enrolled patients on HD for ESRD who underwent TACE for hepatocellular carcinoma. For each patient, we randomly selected up to four non-dialyzed patients using a matched-pair sampling method based on the patient’s age, sex, treatment hospital, and treatment year. In-hospital mortality and complication rates were compared between dialyzed and non-dialyzed patients following TACE. Results: We compared matched pairs of 1551 dialyzed and 5585 non-dialyzed patients. Although the complication rate did not differ between the dialyzed and non-dialyzed ESRD patients [5.7% vs 5.8%, respectively; odds ratio, 0.99; 95% confidence interval (0.79–1.23); p = 0.90], the in-hospital mortality rate was significantly higher in dialyzed ESRD patients than in non-dialyzed patients [2.2% vs 0.97%, respectively; odds ratio, 2.21; 95% confidence interval (1.44–3.40); p < 0.001]. Among the dialyzed patients, the mortality rate was not significantly associated with sex, age, Charlson comorbidity index, or hospital volume. Conclusions: The in-hospital mortality rate following TACE was 2.2 % and was significantly higher in dialyzed than in non-dialyzed ESRD patients. The indications for TACE in HD-dependent patients should be considered carefully with respect to the therapeutic benefits vs risks. Advances in knowledge: In hospital mortality rate following TACE in dialyzed patients was more than twice compared to non-dialyzed patients. Post-procedural complication following TAE in ESRD onHD patients was 5.7%, and did not differ from that in non dialyzed patients.

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Postsurgical multiple-sites sampling procedure for the precise detection of microvascular invasion of hepatocellular carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15657 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15657-e15657

Author(s):

Qian Zhou ◽

Lili Chen ◽

Shuling Chen ◽

Qinghua Cao ◽

Sui Peng ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Tumor Size ◽

Validation Cohort ◽

Normal Liver ◽

Liver Parenchyma ◽

Sampling Procedure ◽

Microvascular Invasion ◽

Sampling Location ◽

Sample Collection ◽

Positive Rate

e15657 Background: Microvascular invasion (MVI) is an important risk factor of recurrence for hepatocellular carcinoma (HCC). We aimed to explore the relationship of the number of sampling sites (NuSS) and sampling location with positive rate of MVI, and investigate cut-off values for NuSS. Methods: From May 2010 to Feb 2017, 910 HCC patients undergone hepatectomy with well-preserved tissue blocks were retrospectively enrolled. Associations between NuSS and positive rates of MVI were investigated. The thresholds of NuSS according to different factors were determined by Chow test and Breakpoints function, and validated prospectively in 118 patients. In validation cohort, MVI positive rates in different sampling locations were estimated. Results: The positive rates of MVI increased as NuSS increased ( P < 0.001). Tumor size and number were two factors influencing NuSS. A minimum of four, six, eight and eight sampling sites were required for detecting MVI in solitary tumors measuring 1.0-3.0 cm, 3.1-4.9 cm and ≥ 5.0 cm and multiple tumors. The positive rates of MVI as per developed thresholds were significantly higher in all the tumor subgroups of validation cohort than those in routine clinical practice in training cohort (46.7% vs. 20.6%, P= 0.048; 44.4% vs. 24.4%, P= 0.025; 73.3% vs. 50.3%, P= 0.004; 67.7% vs. 45.4%, P= 0.026). The positive rates of MVI in tumor interface were higher than those in proximal and distal paracancerous and normal liver parenchyma. Conclusions: The different thresholds of NuSS according to tumor size and number, and sampling distribution according to location provided evidences of standardized sample collection of liver cancer specimen for accurate MVI diagnosis.

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Diagnostic Test of PIVKA-II as A Tumor Marker for Hepatocellular Carcinoma (HCC)

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v26i2.1436 ◽

2020 ◽

Vol 26 (2) ◽

Author(s):

Dwi Priyadi Djatmiko ◽

I Putu Adi Santosa ◽

Elvin Richela Lawanto ◽

Bogi Pratomo ◽

Hani Susianti

Keyword(s):

Hepatocellular Carcinoma ◽

Tumor Marker ◽

Diagnostic Test ◽

Method Comparison ◽

Normal Liver ◽

Diagnostic Value ◽

Roc Curve Analysis ◽

Healthy Control ◽

Cirrhotic Patients ◽

Sensitivity Specificity

Introduction. Alpha-Fetoprotein (AFP) is a tumor marker that has been widely used for HCC, but there has been no increased AFP in 35-45% patients with HCC. Protein induced by vitamin K absence or antagonist II (PIVKA-II) is an abnormal prothrombin secreted in HCC and is expected can be used for HCC diagnostic marker. The objective of this study was to compare serum PIVKA-II levels in the patients with HCC, cirrhosis and healthy control and determine the diagnostic value of PIVKA-II for hepatocellular carcinoma. Methods. This was a cross-section analytic observational study to identify the diagnostic value of PIVKA-II for HCC diagnosis. The diagnosis of 20 cirrhotic patients and 15 patients with HCC was established by history taking, physical examination, and additional examination according to the diagnosis criteria. A group of 12 individuals with normal liver function were used as healthy control subjects. Serum PIVKA-II levels were analyzed with immunoassay method. Comparison study used the Independent-Samples Kruskal Wallis Test. ROC curve analysis and 2x2 contingency table was used to calculate sensitivity, specificity, positive and negative predictive value (PPV and NPV).Results. The serum PIVKA-II level in the patients with HCC was significantly higher than in cirrhotic (p = 0,000) and healthy control patients (p = 0,000). Sensitivity, specificity, PPV, and NPV of PIVKA-II for diagnosis of HCC in cirrhotic patients at a cut-off value of 140.85 mAU/mL were 93.33%, 75%, 73.68%, and 93.75%, respectively (AUC = 0.87).Conclusions and Suggestions. PIVKA-II has high diagnostic value for HCC diagnosis. Diagnostic test that compare serum PIVKA-II level in any size of HCC nodules may be needed in the future.

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Treatment Strategies for Hepatocellular Carcinoma – a Multidisciplinary Approach

International Journal of Molecular Sciences ◽

10.3390/ijms20061465 ◽

2019 ◽

Vol 20 (6) ◽

pp. 1465 ◽

Cited By ~ 26

Author(s):

Isabella Lurje ◽

Zoltan Czigany ◽

Jan Bednarsch ◽

Christoph Roderburg ◽

Peter Isfort ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Disease ◽

Treatment Options ◽

Multidisciplinary Treatment ◽

Treatment Strategies ◽

Future Liver Remnant ◽

Liver Parenchyma ◽

Tumor Stage ◽

Organ Shortage ◽

Liver Remnant

Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver and its mortality is third among all solid tumors, behind carcinomas of the lung and the colon. Despite continuous advancements in the management of this disease, the prognosis for HCC remains inferior compared to other tumor entities. While orthotopic liver transplantation (OLT) and surgical resection are the only two curative treatment options, OLT remains the best treatment strategy as it not only removes the tumor but cures the underlying liver disease. As the applicability of OLT is nowadays limited by organ shortage, major liver resections – even in patients with underlying chronic liver disease – are adopted increasingly into clinical practice. Against the background of the oftentimes present chronical liver disease, locoregional therapies have also gained increasing significance. These strategies range from radiofrequency ablation and trans-arterial chemoembolization to selective internal radiation therapy and are employed in both curative and palliative intent, individually, as a bridging to transplant or in combination with liver resection. The choice of the appropriate treatment, or combination of treatments, should consider the tumor stage, the function of the remaining liver parenchyma, the future liver remnant volume and the patient’s general condition. This review aims to address the topic of multimodal treatment strategies in HCC, highlighting a multidisciplinary treatment approach to further improve outcome in these patients.

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Symptomatic Giant Cavernous Haemangioma of the Liver: Is Enucleation a Safe Method?

HPB Surgery ◽

10.1155/1997/53453 ◽

1997 ◽

Vol 10 (5) ◽

pp. 299-304 ◽

Cited By ~ 10

Author(s):

H. Demiryürek ◽

Ö. Alabaz ◽

D. Ağdemir ◽

I. Sungur ◽

E. U. Erkoçak ◽

...

Keyword(s):

Postoperative Complications ◽

Surgical Technique ◽

Postoperative Bleeding ◽

Normal Liver ◽

Liver Parenchyma ◽

Cavernous Haemangioma ◽

Safe Method ◽

Left Lobectomy ◽

The Mean ◽

Left Lateral Segmentectomy

Twenty-three patients with symptomatic giant hemangioma of the liver were treated by surgery between 1979 and 1996 at the department of General Surgery, Faculty of Medicine, University of Çukurova. Twenty-three enucleations were performed in 21 patients, left lateral segmentectomy in one patient and enucleation plus left lobectomy in one patient. The tumors were enucleated along the interface between the hemangioma and normal liver tissue. The diameters of the tumors ranged from 5×5 to 25×15 cm. The mean blood loss for enucleations was 525 ml (range 500–1000 ml). There was no mortality and no postoperative bleeding. Three patients had postoperative complications. Enucleation is the best surgical technique for symptomatic giant hemangioma of the liver. It may be performed with no mortality, low morbidity and the preservation of all normal liver parenchyma.

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Accumulation of copper and generation of hydroxyl radicals of hepatocellular carcinoma

International Journal of PIXE ◽

10.1142/s0129083501000165 ◽

2001 ◽

Vol 11 (03n04) ◽

pp. 111-118

Author(s):

Hiroyuki Fukuda ◽

Masaaki Ebara ◽

Manaka Arimoto ◽

Masamichi Obu ◽

Shinnen Kin ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatic Fibrosis ◽

Hydroxyl Radicals ◽

High Performance ◽

Normal Liver ◽

Liver Parenchyma ◽

Copper Accumulation ◽

Copper Level ◽

Hepatic Copper ◽

Esr Spin Trapping

Aims: This study evaluated the connection between the progression of hepatic fibrosis and trace metals, the distribution profiles of copper(Cu) and Zinc (Zn) and the generation of hydroxyl radicals from Cu- metallothionein (MT) purified from human hepatocellular carcinoma (HCC). Methods: We measured the metal contents in HCC tissue and liver parenchyma in patients with HCC. The content of metals in the liver was measured by particle induced X-ray emission (PIXE). Distribution profiles of Cu and Zn in human liver was evaluated by high-performance liquid chromatography (HPLC). The generation of hydroxyl radicals was measured by electron spin resonance (ESR) spin-trapping technique. Results: Hepatic copper content increased with the progression of hepatic fibrosis. Copper level in liver parenchyma was higher in patients with HCC than in those without HCC (p < 0.01). MT was mainly present as Zn-MT in normal liver, Cu,Zn-MT in surrounding liver parenchyma and Cu-MT in HCC (p < 0.01). The signal intensity of the ESR spectrum in HCC was stronger than those in normal liver and surrounding liver parenchyma. Conclusions: Copper accumulation in the liver parenchyma seems to relate to hepatocarcinogenesis.

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Quantitative Ultrasound Spectroscopy for Differentiation of Hepatocellular Carcinoma from At-Risk and Normal Liver Parenchyma

Clinical Cancer Research ◽

10.1158/1078-0432.ccr-19-1030 ◽

2019 ◽

Vol 25 (22) ◽

pp. 6683-6691

Author(s):

Isabelle Durot ◽

Rosa M.S. Sigrist ◽

Nishita Kothary ◽

Jarrett Rosenberg ◽

Jürgen K. Willmann ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

At Risk ◽

Quantitative Ultrasound ◽

Normal Liver ◽

Liver Parenchyma ◽

Normal Liver Parenchyma

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Cirrhosis aggravates the ninety-day mortality after liver resection for hepatocellular carcinoma

International Surgery Journal ◽

10.18203/2349-2902.isj20193333 ◽

2019 ◽

Vol 6 (8) ◽

pp. 2869

Author(s):

Hosam Farouk Abdelhameed ◽

Ashraf M. El-Badry

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Hospital Mortality ◽

Postoperative Mortality ◽

University Hospital ◽

Control Group ◽

Complication Rates ◽

Hospital Stays ◽

Cirrhotic Patients ◽

Prolonged Hospital

Background: Ninety-day postoperative mortality (90-D POM) measures accurately the liver resection-related mortality. In cirrhotic patients, reporting post-hepatectomy-related death only as in-hospital or thirty-day postoperative mortality (30-D POM) may underestimate cirrhosis-related death after liver resection.Methods: Medical records of adult cirrhotic (cirrhosis group) and matched non-cirrhotic (control group) patients, who underwent elective liver resection at Sohag University Hospital (April 2014- March 2018), were analyzed. The 90-D POM versus in-hospital mortality and 30-D POM were compared in both groups.Results: Forty-six patients (23 per group) were eligible for the study. Liver resection was carried out in all cirrhosis group patients for hepatocellular carcinoma (HCC). In the control group, liver resection was indicated for colorectal metastasis (13), benign masses (7) and intrahepatic cholangiocarcinoma (3). Compared with the control group, cirrhotic patients exhibited significantly higher complication rates (p<0.05), prolonged hospital stays (p<0.05), increased postoperative levels of serum bilirubin and reduced prothrombin concentration (p<0.05). In the control group, in-hospital mortality and 30-D POM were zero while 90-D POM was 4%. In the cirrhosis group, the in-hospital mortality and 30-D POM were identical (8.7%), however the 90-D POM was significantly higher and almost doubled (17%). Conclusion: Liver cirrhosis triggers significant mortality that may extend for ninety days postoperatively. In cirrhotic patients, post-hepatectomy death should be reported as 90-D POM rather than the obviously misleading in-hospital mortality or 30-D POM.

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Ultrasonography in the study of hepatocellular carcinoma in woodchucks chronically infected with WHV

Laboratory Animals ◽

10.1258/002367703766453083 ◽

2003 ◽

Vol 37 (3) ◽

pp. 233-240 ◽

Cited By ~ 8

Author(s):

D. Lisi ◽

L. A. Kondili ◽

M. T. Ramieri ◽

R. Giuseppetti ◽

R. Bruni ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis Virus ◽

Early Stage ◽

False Negative ◽

Normal Liver ◽

Liver Parenchyma ◽

Microscopical Examination ◽

Negative Results ◽

Chronic Hepatitis B Virus ◽

Us Findings

The woodchuck hepatitis virus (WHV)/woodchuck system is studied as animal model of human hepatocellular carcinoma (HCC) induced by chronic hepatitis B virus infection. The aim of the present study was the evaluation of ultrasound (US) liver examination in woodchuck as a routine method to detect HCC nodules and to follow their growth. Sixteen woodchucks were included in the study. US liver examination was carried out in all animals using a 5 MHz convex scanner. Macroscopic and microscopic examinations were performed to evaluate the US findings. The lower limit of nodule detection by US examination was a diameter of 5 mm. Macroscopic and microscopic examinations confirmed US findings in 14 of 16 animals (86.6%). No false negative results were obtained. Increase of nodule size was faster in the early phase of tumour growth. Small nodules (16 ± 5 mm) appeared as hypoechoic lesions with well-defined margins and homogeneous structure. Large nodules (42 ± 19 mm) appeared as hyperechoic lesions with irregular margins, heterogeneous or of mixed pattern; microscopical examination showed different degrees of necrosis, inflammation and fibrosis inside these latter neoplasms. The hepatitis reaction was conspicuously more severe around HCC nodules. No fibrosis and/or cirrhosis were found in normal liver parenchyma surrounding tumour nodules. On the whole, US appears to be helpful in the diagnosis of woodchuck HCC even at an early stage. Serial US evaluation can be used to study the growth rate of tumour nodules during natural history or experimental HCC treatments in woodchuck.

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