Validation of the Conventional Resection Criteria in Patients with Hepatocellular Carcinoma in Terms of the Incidence of Posthepatectomy Liver Failure and Long-Term Prognosis

2015 ◽  
Vol 32 (5) ◽  
pp. 344-351 ◽  
Author(s):  
Kohta Iguchi ◽  
Etsuro Hatano ◽  
Kenya Yamanaka ◽  
Shiro Tanaka ◽  
Kojiro Taura ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Failure ◽  
Disease Free Survival ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Free Survival ◽  
Posthepatectomy Liver Failure ◽  
Long Term Prognosis ◽  
Patient Prognosis

Background/Aims: Resection criteria in hepatocellular carcinoma (HCC) should be established based on the risk of posthepatectomy liver failure (PHLF) and the survival benefit from hepatectomy. This study aimed at verifying the validity of the conventional criteria regarding the incidence of PHLF and the long-term prognosis of HCC patients. Methods: A retrospective study was performed on 265 patients who underwent major hepatectomy. Makuuchi's criteria and the future liver remnant plasma clearance rate of indocyanine green (ICGK-rem) ≥0.05 criterion were evaluated. Results: A total of 107 and 158 patients were within and beyond Makuuchi's criteria, respectively. Makuuchi's criteria were associated with the incidence of PHLF (p = 0.03) but not with its severity (p = 0.12). No differences in disease-free survival (DFS) or overall survival (OS) were observed between the groups (p = 0.75 and p = 0.94, respectively). Using the ICGK-rem ≥0.05 criterion, 223 and 42 patients were within and beyond the criterion, respectively. ICGK-rem was correlated with both the incidence of PHLF (p = 0.002) and its severity (p = 0.03). No differences in DFS or OS were observed between the groups (p = 0.75 and p = 0.29, respectively). Conclusions: Strict criteria are likely to preclude some patients from obtaining the greater survival benefits of hepatectomy. New criteria that consider patient prognosis are needed.

scholarly journals Major Hepatectomy in a Child with Extremely Low Future Liver Remnant Without Posthepatectomy Liver Failure

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S201
Author(s):  
D. Akhaladze ◽  
D. Kachanov ◽  
G. Rabaev ◽  
N. Merkulov ◽  
N. Uskova ◽  
...  
Keyword(s):  
Liver Failure ◽  
Major Hepatectomy ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Posthepatectomy Liver Failure

Surgical Outcomes in Hepatitis C Virus-Related Hepatocellular Carcinoma: Special Reference to Sustained Virological Responses to Interferon Therapy

2017 ◽  
Vol 83 (11) ◽  
pp. 1246-1255 ◽  
Author(s):  
Shogo Tanaka ◽  
Akihiro Tamori ◽  
Shigekazu Takemura ◽  
Genya Hamano ◽  
Tokuji Ito ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatitis C ◽  
Hepatic Resection ◽  
Surgical Outcomes ◽  
Interferon Therapy ◽  
Disease Free Survival ◽  
Control Group ◽  
Free Survival ◽  
Disease Free

Long-term surgical outcomes after hepatic resection for hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) in patients who achieved a sustained virological response (SVR) to interferon (IFN) therapy remain inconclusive. Clinical records of 277 patients who underwent hepatic resection for HCV-related early stage HCC (met the Milan criteria) between 1993 and 2012 were retrospectively reviewed. Thirty-seven patients achieved the SVR during HCC detection (pre-SVR group), whereas 23 achieved SVR using adjuvant interferon therapy after hepatic resection (post-SVR group). The control group included remaining 217 patients. We investigated the SVR effects on surgical outcomes. Disease-free survival (DFS) rates at 5/10/15 years after hepatic resection were significantly greater in the pre and post-SVR groups than in the control group (46/30/30per cent and 61/36/27 per cent vs 23/7/7 per cent, respectively; P < 0.001). Overall survival (OS) rates at 10/15 years after hepatic resection were better in the pre- and post-SVR groups than in the control group (68/68 percent and 78/78 per cent vs 13/11 per cent, respectively; P < 0.001). On multivariate analysis, pre- and post-SVR were independent factors for no recurrence (pre-SVR: hazard ratio (HR), 0.48, P = 0.002; post-SVR: HR, 0.41, P = 0.001) and improved survival (pre-SVR: HR, 0.36, P = 0.002; post-SVR: HR, 0.122, P < 0.001). Achievement of SVR in patients with HCV-related HCC was associated with long-term disease-free survival and OS after hepatic resection.

scholarly journals Assessment of Liver Remnant Using ICG Clearance Intraoperatively during Vascular Exclusion: Early Experience with the ALIIVE Technique

HPB Surgery ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Lawrence Lau ◽  
Christopher Christophi ◽  
Mehrdad Nikfarjam ◽  
Graham Starkey ◽  
Mark Goodwin ◽  
...  
Keyword(s):  
Liver Failure ◽  
Major Hepatectomy ◽  
Significant Risk ◽  
Future Liver Remnant ◽  
Preoperative Assessment ◽  
Parenchymal Transection ◽  
Liver Remnant ◽  
Posthepatectomy Liver Failure ◽  
Vascular Exclusion ◽  
Icg Clearance

Background. The most significant risk following major hepatectomy is postoperative liver insufficiency. Current preoperative assessment of the future liver remnant relies upon assumptions which may not be valid in the setting of advanced resection strategies. This paper reports the feasibility of the ALIIVE technique which assesses the liver remnant with ICG clearance intraoperatively during vascular exclusion. Methods. 10 patients undergoing planned major liver resection (hemihepatectomy or greater) were recruited. Routine preoperative assessment included CT and standardized volumetry. ICG clearance was measured noninvasively using a finger spectrophotometer at various time points including following parenchymal transection during inflow and outflow occlusion before vascular division, the ALIIVE step. Results. There were one case of mortality and three cases of posthepatectomy liver failure. The patient who died had the lowest ALIIVE ICG clearance (7.1%/min versus 14.4 ± 4.9). Routine preoperative CT and standardized volumetry did not predict outcome. Discussion/Conclusion. The novel ALIIVE technique is feasible and assesses actual future liver remnant function before the point of no return during major hepatectomy. This technique may be useful as a check step to offer a margin of safety to prevent posthepatectomy liver failure and death. Further confirmatory studies are required to determine a safety cutoff level.

scholarly journals Laparoscopically Resected Solitary Metastasis of Hepatocellular Carcinoma to the Round Ligament

2016 ◽  
Vol 101 (7-8) ◽  
pp. 334-337 ◽  
Author(s):  
SiYuan Yao ◽  
Atsushi Ikeda ◽  
Teppei Murakami ◽  
Tatsuo Okumoto ◽  
Eiji Tanaka ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Disease Free Survival ◽  
Laparoscopic Approach ◽  
Distant Metastases ◽  
Round Ligament ◽  
Perioperative Outcomes ◽  
Free Survival ◽  
Rare Site ◽  
Lung Lymph

Hepatocellular carcinoma (HCC) is known to metastasize to the lung, lymph node, and musculoskeletal regions; however, to our knowledge, metastasis to the round ligament of the liver has never been reported. In addition, because the conventional approach for surgical resection of intra-abdominal metastasis is open surgery, the laparoscopic approach has been rarely performed. This report presents the case of a 72-year-old Asian man who developed a tumor in the round ligament, a rare site for distant metastases, 2 years after complete resection of an HCC. As the tumor was solitary and noninvasive, laparoscopic resection was planned and safely performed. He has now been free of recurrence for more than 3 years. Good perioperative outcomes and a long-term disease-free survival were thus achieved with minimally invasive surgery. In addition to being the first report of this rare recurrence site, this is also the first reported case of resection of an extrahepatic metastasis by laparoscopic surgery alone. This report may encourage surgeons to select a laparoscopic approach when managing intra-abdominal metastases from an HCC.

Insights From Mixture Cure Modeling of Molecular Markers for Prognosis in Breast Cancer

2013 ◽  
Vol 31 (16) ◽  
pp. 2047-2054 ◽  
Author(s):  
Yildiz E. Yilmaz ◽  
Jerald F. Lawless ◽  
Irene L. Andrulis ◽  
Shelley B. Bull
Keyword(s):  
Breast Cancer ◽  
Molecular Genetic ◽  
Disease Free Survival ◽  
Disease Recurrence ◽  
Survival Models ◽  
Axillary Lymph ◽  
Free Survival ◽  
Long Term Prognosis ◽  
Disease Free

With the ultimate aim of improving clinical management of breast cancer, investigators have sought to identify molecular genetic markers that stratify newly diagnosed patients into subtypes differing in short- or long-term prognosis. Conventional survival models can fail to describe adequately the relationship between subtype and disease recurrence, particularly when there is a substantial proportion of long-term disease-free survivors. The observed patterns of disease-free survival in an undifferentiated patient cohort may be explained by an underlying mixture of two subgroups: patients who will remain free of disease in the long term (ie, cured), and those who will experience disease recurrence within their lifetime (ie, susceptible.) In this article, we review the concepts and methods of the mixture cure models and apply them in the analysis of molecular genetic prognostic factors for disease-free survival and time to disease recurrence in a cohort of patients with axillary lymph node–negative breast cancer.

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