scholarly journals IS RESECTION OF HEPATOCELLULAR CARCINOMA IN THE ERA OF LIVER TRANSPLANTATION WORTHWILE? A single center experience

2016 ◽  
Vol 53 (3) ◽  
pp. 169-174 ◽  
Author(s):  
Paulo HERMAN ◽  
Felipe de Lucena Moreira LOPES ◽  
Jaime Arthur Pirola KRUGER ◽  
Gilton Marques FONSECA ◽  
Vagner Birk JEISMANN ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Liver Resection ◽  
Liver Function ◽  
Univariate Analysis ◽  
Alpha Fetoprotein ◽  
Waiting List ◽  
Long Term Results ◽  
Open Approach ◽  
Single Center

ABSTRACT Background - Liver resection for hepatocellular carcinoma is a potentially curative therapeutic procedure that can be performed readily after its indication, without the need of a long waiting time and lower costs when compared to liver transplantation, being a good alternative in patients with preserved/good liver function. Objective - Evaluate long-term results of liver resection from a high volume single center for selected patients with hepatocellular carcinoma in a context of a long waiting list for liver transplant. Methods - One hundred and one patients with hepatocellular carcinoma, with a mean age of 63.1 years, and preserved liver function were submitted to liver resection. Clinical and pathological data were evaluated as prognostic factors. Mean follow-up was 39.3 months. Results - All patients had a single nodule and 57 (58.2%) patients were within the Milan criteria. The size of the nodule ranged from 1 to 24 cm in diameter. In 74 patients, liver resection was performed with the open approach and in 27 (26.7%) was done laparoscopically. Postoperative morbidity was 55.3% being 75.5% of the complications classified as Dindo-Clavien I and II and operative mortality was 6.9%. Five-year overall and disease free survival rates were 49.9% and 40.7%, respectively.After a log-rank univariate analysis, the levels of preoperative alpha-fetoprotein (P=0.043), CA19-9 (P=0.028), capsule invasion (P=0.03), positive margin (R1-R2) (P=0.004) and Dindo-Claviens' morbidity classification IV (P=0.001) were the only parameters that had a significant negative impact on overall survival. On the odds-ratio evaluation, the only significant factors for survival were high levels of alpha-fetoprotein (P=0.037), and absence of free margins (P=0.008). Conclusion - Resection, for selected cases, is a potentially curative treatment with acceptable morbidity and mortality and, in a context of a long waiting list for transplant, plays an important role for the treatment of hepatocellular carcinoma.

scholarly journals Liver Transplantation for Extended Criteria Hepatocellular Carcinoma Using Stable Response to Locoregional Therapy and Alpha-Fetoprotein as Selection Criteria

2020 ◽  
Vol 36 (6) ◽  
pp. 506-515
Author(s):  
Markus Bo Schoenberg ◽  
Hubertus Johann Wolfgang Anger ◽  
Julian Nikolaus Bucher ◽  
Gerald Denk ◽  
Enrico Narciso De Toni ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Selection Criteria ◽  
Validation Cohort ◽  
Alpha Fetoprotein ◽  
Long Term Results ◽  
Locoregional Therapy ◽  
Internal Validation ◽  
Dynamic Selection ◽  
Transplant Candidates

<b><i>Introduction:</i></b> Current practice to only prioritize hepatocellular carcinoma (HCC) that fulfill the Milan criteria (IN<sub>MC</sub>) is changing, since it causes the exclusion of patients who could benefit from liver transplantation. To select patients outside MC (OUT<sub>MC</sub>) for transplantation, we implemented extended selection criteria without up-front morphometric restrictions containing surrogate parameters of tumor biology. <b><i>Methods:</i></b> OUT<sub>MC</sub> patients were considered without restrictions of morphometrics and received locoregional treatment after interdisciplinary consultation. Our dynamic selection criteria for OUT<sub>MC</sub> patients required (IN<sub>MUC</sub>): (1) treatment response over (2) at least 6 months and (3) alpha-fetoprotein ≤400 ng/mL over the entire evaluation period. Patients with IN<sub>MC</sub> tumors served as control and internal validation cohort. <b><i>Results:</i></b> 31 of 170 liver transplant candidates were OUT<sub>MC</sub>. Of these, 8 dropped out. The remaining 23 patients met the selection criteria and underwent transplantation. Recurrence-free survival was higher in patients transplanted IN<sub>MC</sub> compared to those OUT<sub>MC</sub> IN<sub>MUC</sub> (92.2% vs. 70.8%; <i>p</i> = 0.026) after 5 years of follow-up. Overall survival showed no significant difference (<i>p</i> = 0.552). With dynamic selection of transplant candidates, recurrence could also be predicted for the IN<sub>MC</sub> patients as internal validation cohort (c-index: 0.896; CI 0.588–0.981, <i>p</i> = 0.005). <b><i>Conclusion:</i></b> Dynamic selection criteria for the stratification of patients with OUT<sub>MC</sub> HCCs is feasible and allows for excellent long-term results and acceptable tumor recurrence rates comparable to IN<sub>MC</sub> patients.

scholarly journals Preoperative Alpha-Fetoprotein Slope is Predictive of Hepatocellular Carcinoma Recurrence after Liver Transplantation

2007 ◽  
Vol 21 (1) ◽  
pp. 39-45 ◽  
Author(s):  
Kathy Han ◽  
George N Tzimas ◽  
Jeffrey S Barkun ◽  
Peter Metrakos ◽  
Jean I Tchervenkov ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Univariate Analysis ◽  
Health Centre ◽  
Prognostic Significance ◽  
Alpha Fetoprotein ◽  
Tumour Recurrence ◽  
Recurrence Free Survival ◽  
Characteristic Analysis ◽  
Free Survival

BACKGROUND: Liver transplantation (LT) offers a possible cure for patients with hepatocellular carcinoma (HCC) and cirrhosis. However, tumour progression while on the waiting list and tumour recurrence after LT are common. The prognostic significance of various pre- and postoperative variables were investigated in regard to tumour recurrence, with an emphasis on the slope of preoperative serum alpha-fetoprotein (AFP) levels.PATIENTS AND METHODS: Data from 48 patients who had HCC diagnosed preoperatively and underwent LT at the McGill University Health Centre (Montreal, Quebec) were reviewed retrospectively, and possible risk factors for tumour recurrence were examined.RESULTS: Univariate analysis revealed a positive correlation between the preoperative AFP slope and vascular invasion (P = 0.045), total tumour diameter at explant (P = 0.040), Cancer of the Liver Italian Program score (P = 0.017) and recurrence-free survival (P = 0.028). Of the preoperative variables examined, only the preoperative AFP slope was identified as an independent predictor of tumour recurrence by multivariate analysis. Receiver operating characteristic analysis showed that the best discriminant cut-off value, calculated as the value of the maximized likelihood ratio, was preoperative AFP slope greater than 50 µg/L per month. At this cut-off, sensitivity was 36%, and specificity was 97%. Patients with a preoperative AFP slope greater than 50 µg/L per month had a much worse one-year recurrence-free survival rate than those with a preoperative AFP slope 50 µg/L per month or less (40% versus 90%, P < 0.001).CONCLUSIONS: These results suggest that the preoperative AFP slope is an important predictor of HCC recurrence after LT and should be examined in future studies of patients receiving LT for HCC.

Impact of margin status on long-term results of liver resection for hepatocellular carcinoma: single-center time-to-recurrence analysis

2019 ◽  
Vol 72 (1) ◽  
pp. 109-117 ◽  
Author(s):  
Salvatore Gruttadauria ◽  
Duilio Pagano ◽  
Lidia R. Corsini ◽  
Davide Cintorino ◽  
Sergio Li Petri ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Margin Status ◽  
Long Term Results ◽  
Single Center ◽  
Recurrence Analysis ◽  
Time To Recurrence ◽  
Center Time ◽  
Results Of Liver Resection

scholarly journals LIVER TRANSPLANTATION FOR BILE DUCT INJURY AFTER CHOLECYSTECTOMY

2019 ◽  
Vol 56 (3) ◽  
pp. 300-303
Author(s):  
José Francisco Rêgo e SILVA FILHO ◽  
Gustavo Rêgo COELHO ◽  
José Alberto Dias LEITE FILHO ◽  
Paulo Everton Garcia COSTA ◽  
Marcos Aurelio Pessoa BARROS ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Laparoscopic Approach ◽  
Waiting List ◽  
Red Blood Cell Transfusion ◽  
Biliary Cirrhosis ◽  
Open Approach ◽  
Single Center ◽  
Study Results

ABSTRACT BACKGROUND: Bile duct injury is a life-threatening complication that requires proper management to prevent the onset of negative outcomes. Patients may experience repeated episodes of cholangitis, secondary biliary cirrhosis, end-stage liver disease and death. OBJECTIVE: To report a single center experience in iatrogenic secondary liver transplantation after cholecystectomy and review the literature. METHODS: This was a retrospective single center study. Of the 1662 liver transplantation realized, 10 (0.60 %) were secondary to iatrogenic bile ducts injuries due cholecystectomies. Medical records of these patients were reviewed in this study. RESULTS: Nine of 10 patients were women; the median time in waiting list and between cholecystectomy and inclusion in waiting list was of 222 days and of 139.9 months, respectively. Cholecystectomy was performed by open approach in eight (80%) cases and by laparoscopic approach in two (20%) cases. The patients underwent an average of 3.5 surgeries and procedures before liver transplantation. Biliary reconstruction was realized with a Roux-en-Y hepaticojejunostomy in nine (90%) cases. Mean operative time was 447.2 minutes and the median red blood cell transfusion was 3.4 units per patient. Mortality in the first month was of 30%. CONCLUSION: Although the liver transplantation is an extreme treatment for an initially benign disease, it has its well-defined indications in treatment of bile duct injuries after cholecystectomy, either in acute or chronic scenario.

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