Current Role of Surgery in Treatment of Early Stage Hepatocellular Carcinoma: Resection versus Liver Transplantation

Oncology ◽  
2008 ◽  
Vol 75 (1) ◽  
pp. 124-128 ◽  
Author(s):  
Nam-Joon Yi ◽  
Kyung-Suk Suh ◽  
Taehoon Kim ◽  
Joohyun Kim ◽  
Woo Young Shin ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Early Stage ◽  
Current Role

scholarly journals Role of Pretransplant Treatments for Patients with Hepatocellular Carcinoma Waiting for Liver Transplantation

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 396
Author(s):  
Kohei Ogawa ◽  
Yasutsugu Takada
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Early Stage ◽  
Deceased Donor ◽  
Locoregional Therapy ◽  
Curative Intent ◽  
Liver Functional Reserve ◽  
Deceased Donors ◽  
Drop Outs

Recently, there have been many reports of the usefulness of locoregional therapy such as transarterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma (HCC) as pretreatment before liver transplantation (LT). Locoregional therapy is performed with curative intent in Japan, where living donor LT constitutes the majority of LT due to the critical shortage of deceased donors. However, in Western countries, where deceased donor LT is the main procedure, LT is indicated for early-stage HCC regardless of liver functional reserve, and locoregional therapy is used for bridging until transplantation to prevent drop-outs from the waiting list or for downstaging to treat patients with advanced HCC who initially exceed the criteria for LT. There are many reports of the effect of bridging and downstaging locoregional therapy before LT, and its indications and efficacy are becoming clear. Responses to locoregional therapy, such as changes in tumor markers, the avidity of FDG-PET, etc., are considered useful for successful bridging and downstaging. In this review, the effects of bridging and downstaging locoregional therapy as a pretransplant treatment on the results of transplantation are clarified, focusing on recent reports.

scholarly journals The Treatment Effect of Liver Transplantation versus Liver Resection for HCC: A Review and Future Perspectives

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3730
Author(s):  
Berend R. Beumer ◽  
Roeland F. de Wilde ◽  
Herold J. Metselaar ◽  
Robert A. de Man ◽  
Wojciech G. Polak ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Liver Resection ◽  
Early Stage ◽  
Disease Free Survival ◽  
Milan Criteria ◽  
Term Survival ◽  
Equal Distribution ◽  
Intention To Treat ◽  
Treat Analysis

For patients presenting with hepatocellular carcinoma within the Milan criteria, either liver resection or liver transplantation can be performed. However, to what extent either of these treatment options is superior in terms of long-term survival is unknown. Obviously, the comparison of these treatments is complicated by several selection processes. In this article, we comprehensively review the current literature with a focus on factors accounting for selection bias. Thus far, studies that did not perform an intention-to-treat analysis conclude that liver transplantation is superior to liver resection for early-stage hepatocellular carcinoma. In contrast, studies performing an intention-to-treat analysis state that survival is comparable between both modalities. Furthermore, all studies demonstrate that disease-free survival is longer after liver transplantation compared to liver resection. With respect to the latter, implications of recurrences for survival are rarely discussed. Heterogeneous treatment effects and logical inconsistencies indicate that studies with a higher level of evidence are needed to determine if liver transplantation offers a survival benefit over liver resection. However, randomised controlled trials, as the golden standard, are believed to be infeasible. Therefore, we suggest an alternative research design from the causal inference literature. The rationale for a regression discontinuity design that exploits the natural experiment created by the widely adopted Milan criteria will be discussed. In this type of study, the analysis is focused on liver transplantation patients just within the Milan criteria and liver resection patients just outside, hereby ensuring equal distribution of confounders.

Complications of cirrhosis and portal hypertension

2013 ◽  
pp. 251-256 ◽  
Author(s):  
Daniel Marks ◽  
Marcus Harbord
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Spontaneous Bacterial Peritonitis ◽  
Early Stage ◽  
Nodule Formation ◽  
Architectural Distortion ◽  
Bacterial Peritonitis ◽  
Complications Of Cirrhosis

Causes and diagnosis of cirrhosis Causes and diagnosis of non-cirrhotic portal hypertension Ascites Spontaneous bacterial peritonitis Hepatorenal syndrome Variceal haemorrhage Hepatic encephalopathy Hepatopulmonary syndromes Hepatocellular carcinoma Cirrhosis occurs following progressive hepatic fibrosis, with architectural distortion of the liver and nodule formation. It is a histological diagnosis. Late-stage cirrhosis is irreversible, at which point only liver transplantation is curative. Early-stage cirrhosis has been shown to improve following treatment and may be asymptomatic....

scholarly journals Role of SIRT-3, p-mTOR and HIF-1α in Hepatocellular Carcinoma Patients Affected by Metabolic Dysfunctions and in Chronic Treatment with Metformin

2019 ◽  
Vol 20 (6) ◽  
pp. 1503 ◽  
Author(s):  
Serena De Matteis ◽  
Emanuela Scarpi ◽  
Anna Granato ◽  
Umberto Vespasiani-Gentilucci ◽  
Giuliano La Barba ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Early Stage ◽  
Mammalian Target Of Rapamycin ◽  
Hypoxia Inducible Factor ◽  
Significant Benefit ◽  
Diabetic Patients ◽  
Advanced Stage ◽  
Metabolic Dysfunctions ◽  
Worse Prognosis

The incidence of hepatocellular carcinoma deriving from metabolic dysfunctions has increased in the last years. Sirtuin- (SIRT-3), phospho-mammalian target of rapamycin (p-mTOR) and hypoxia-inducible factor- (HIF-1α) are involved in metabolism and cancer. However, their role in hepatocellular carcinoma (HCC) metabolism, drug resistance and progression remains unclear. This study aimed to better clarify the biological and clinical function of these markers in HCC patients, in relation to the presence of metabolic alterations, metformin therapy and clinical outcome. A total of 70 HCC patients were enrolled: 48 and 22 of whom were in early stage and advanced stage, respectively. The expression levels of the three markers were assessed by immunohistochemistry and summarized using descriptive statistics. SIRT-3 expression was higher in diabetic than non-diabetic patients, and in metformin-treated than insulin-treated patients. Interestingly, p-mTOR was higher in patients with metabolic syndrome than those with different etiology, and, similar to SIRT-3, in metformin-treated than insulin-treated patients. Moreover, our results describe a slight, albeit not significant, benefit of high SIRT-3 and a significant benefit of high nuclear HIF-1α expression in early-stage patients, whereas high levels of p-mTOR correlated with worse prognosis in advanced-stage patients. Our study highlighted the involvement of SIRT-3 and p-mTOR in metabolic dysfunctions that occur in HCC patients, and suggested SIRT-3 and HIF-1α as predictors of prognosis in early-stage HCC patients, and p-mTOR as target for the treatment of advanced-stage HCC.

Role of Osteopontin and CD44s Expression for Patients With Hepatocellular Carcinoma Undergoing Liver Transplantation or Resection

2008 ◽  
Vol 40 (9) ◽  
pp. 3182-3184 ◽  
Author(s):  
S. Beckebaum ◽  
X. Chen ◽  
G.C. Sotiropoulos ◽  
A. Radtke ◽  
M. Daoudaki ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Cd44s Expression
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