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Radiofrequency Ablation Plus Devascularization Is the Preferred Treatment of Hepatocellular Carcinoma with Esophageal Varices

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Abstract

Background

Most hepatocellular carcinomas (HCCs) are associated with cirrhosis. Portal hypertension (PHT) and esophageal variceal bleeding (EVB) can limit the patient’s treatment options. Surgical therapy in such patients is challenging. We performed devascularization plus liver resection or radiofrequency ablation (RFA) to treat HCC patients with concomitant EVB resulting from PHT secondary to cirrhosis. Such combined operations have never been reported for the management of HCC patients with variceal esophageal bleeding.

Aim

To evaluate two different treatment regimens for patients with HCC and EVB.

Methods

We evaluated 35 BCLC stage 0/A patients with HCC and EVB who underwent either devascularization plus liver resection (Group A) or devascularization plus RFA (Group B). We reviewed the safety and outcomes of the two groups and assessed risk factors for patient survival and tumor recurrence.

Results

Significant factors for overall survival were surgical approach and Child-Pugh classification. Child-Pugh classification was the only independent risk factor for overall postoperative survival [hazard ratio (HR) 8.320, 95 % confidence interval (CI) 1.739–39.799, P = 0.008]. Age was the only independent risk factor for tumor recurrence (HR 4.025, 95 % CI 1.343–12.062, P = 0.013).

Conclusions

RFA plus devascularization is the preferred treatment of HCC with EVB. RFA plus devascularization should be considered in Child-Pugh class A patients below 50 years of age.

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Acknowledgments

This study was funded in full by the Beijing Municipal Science and Technology Commission Capital Characteristic Clinical Application Research (No. Z121107001012169) and Capital Medical University, Beijing Ditan Hospital Research Fund Project (No. QN2011-04).

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Beijing DiTan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China

    Ke Zhang, Li Jiang, Zhe Jia, Rong He, Zhenhao Ding & Yi Mu

  2. Department of Ultrasonic Diagnosis, Beijing DiTan Hospital, Capital Medical University, Beijing, 100015, China

    Yao Zhang

Authors
  1. Ke Zhang
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  2. Li Jiang
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  3. Zhe Jia
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  4. Yao Zhang
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  5. Rong He
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  6. Zhenhao Ding
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  7. Yi Mu
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Corresponding author

Correspondence to Yi Mu.

Additional information

Ke Zhang, Li Jiang, and Zhe Jia have contributed equally to this work.

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Zhang, K., Jiang, L., Jia, Z. et al. Radiofrequency Ablation Plus Devascularization Is the Preferred Treatment of Hepatocellular Carcinoma with Esophageal Varices. Dig Dis Sci 60, 1490–1501 (2015). https://doi.org/10.1007/s10620-014-3455-1

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  • DOI: https://doi.org/10.1007/s10620-014-3455-1

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