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Is There any Benefit from Expanding the Criteria for the Resection of Hepatocellular Carcinoma in Cirrhotic Liver? Experience from a Developing Country

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Abstract

Background

Patients with large-size (>10 cm) hepatocellular carcinoma (HCC) in Child B cirrhosis are usually excluded from curative treatment, i.e., hepatic resection, because of marginal liver function and poor outcome. This study was designed to evaluate the feasibility of the radiofrequency (RF)-assisted sequential “coagulate-cut liver resection technique” in expanding the criteria for resection of large HCC in cirrhotic livers with impaired liver function.

Methods

Forty patients with Child-Pugh A or B cirrhosis underwent liver resection from December 1, 2001 to December 31, 2008. Of these, 20 patients (13 Child-Pugh A and 7 Child-Pugh B) with advanced stage HCC (stage B and C according to Barcelona-Clinic Liver Cancer Group) underwent major liver resection. The two groups were comparable in terms of patient age, liver cirrhosis etiology, tumor number, and size.

Results

All resections were performed without the Pringle maneuver. There was no significant difference found between the two groups regarding resection time, perioperative transfusion, postoperative complications, hospital stay, and day 7 values of hemoglobin and liver enzymes. Likewise, there was no significant difference found in the overall survival between Child A and Child B patients who underwent major liver resection

Conclusions

RF-assisted sequentional “coagulate-cut liver resection technique“ may be a viable alternative for management of patients with advanced HCC in cirrhotic liver with impaired function.

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References

  1. Poon RT, Fan ST, Lo CM et al (2000) Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 234:63–70

    Article  Google Scholar 

  2. Moser MAJ, Kneteman NM, Minuk GY (2000) Research toward safer resection of the cirrhotic liver [review]. HPB Surg 11:285–297

    Article  PubMed  CAS  Google Scholar 

  3. Abdalla E, Denys A, Hasegawa K et al (2008) Treatment of large and advanced hepatocellular carcinoma. Ann Surg Oncol 15(4):979–985

    Article  PubMed  Google Scholar 

  4. Ruzzenente A, Capra F, Pachera S et al (2009) Is liver resection justified in advanced hepatocellular carcinoma? Results of an observational study in 464 patients. J Gastrointest Surg 13:1313–1320

    Article  PubMed  Google Scholar 

  5. Ng KK, Vauthey JN, Pawlik T et al (2005) Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database. Ann Surg Oncol 12(5):1–10

    Article  Google Scholar 

  6. Forner A, Reig M, de Lope CR et al (2010) Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 30:61–74

    Article  PubMed  CAS  Google Scholar 

  7. Marrero J, Fontana R, Barrat A et al (2005) Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology 41(4):707–715

    Article  PubMed  Google Scholar 

  8. Ferenci P, Fried M, Labrecque D et al (2010) Hepatocellular carcinoma (HCC): a global perspective. J Clin Gastroenterol 44(4):239–245

    Article  PubMed  Google Scholar 

  9. Tan CK, Law NM, Ng HS et al (2003) Simple clinical prognostic model for hepatocellular carcinoma in developing countries and its validation. J Clin Oncol 21:2294–2298

    Article  PubMed  Google Scholar 

  10. Ishizawa T, Hasegawa K, Aoki T et al (2008) Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology 134:1908–1916

    Article  PubMed  Google Scholar 

  11. Poon RT, Fan ST (2004) Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome. Liver Transpl 10(2 Suppl 1):39–45

    Article  CAS  Google Scholar 

  12. Katz SC, Shia J, Liau KH et al (2009) Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg 249:617–623

    Article  PubMed  Google Scholar 

  13. van der Bilt JDW, Livestro DP, Borren A et al (2007) European survey on the application of vascular clamping in liver surgery. Dig Surg 24:423–435

    Article  PubMed  Google Scholar 

  14. van Gulik T, de Graaf W, Dinant S et al (2007) Vascular occlusion techniques during liver resection. Dig Surg 24:274–281

    Article  PubMed  Google Scholar 

  15. Sugiyama Y, Ishizaki Y, Imamura H et al (2010) Effects of intermittent Pringle’s maneuver on cirrhotic compared with normal liver. BJS 97:1062–1069

    Article  CAS  Google Scholar 

  16. Si-Yuan FU, Yee LW, Guang-Gang L et al (2011) A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy. Am J Surg 201(1):62–69

    Article  PubMed  Google Scholar 

  17. Milicevic M, Bulajic P, Zuvela M et al (2007) Radiofrequency-assisted minimal blood loss liver parenchyma dissection technique. Dig Surg 24:306–313

    Article  PubMed  Google Scholar 

  18. Weber JC, Navarra G, Jiao LR et al (2002) New technique for liver resection using heat coagulative necrosis. Ann Surg 236:560–563

    Article  PubMed  Google Scholar 

  19. Ayav A, Bachellier P, Habib N et al (2007) Impact of radiofrequency assisted hepatectomy for reduction of transfusion requirements. Am J Surg 193:143–148

    Article  PubMed  Google Scholar 

  20. Curro G, Habib N, Jiao L et al (2008) Radiofrequency-assisted liver resection in patients with hepatocellular carcinoma and cirrhosis: preliminary results. Transplant Proc 40:3523–3525

    Article  PubMed  CAS  Google Scholar 

  21. Mitsuo M, Takahiro T, Yasuko T et al (2007) Radiofrequency (RF)-assisted hepatectomy may induce severe postoperative liver damage. World J Surg 31:2208–2212. doi:10.1007/s00268-007-9205-1

    Article  PubMed  Google Scholar 

  22. Jiao LR, Tierris I, Ayav A et al (2006) A new technique for spleen preservation with radiofrequency. Surgery 140:464–466

    Article  PubMed  Google Scholar 

  23. Berber E, Siperstein A (2008) Radiofrequency (RF)-assisted hepatectomy may induce severe liver damage. World J Surg 32:1897–1898. doi:10.1007/s00268-007-9430-7

    Article  PubMed  Google Scholar 

  24. Lupo L, Gallerani A, Panzera P et al (2007) Randomized clinical trial of radiofrequency-assisted versus clamp-crushing liver resection. Br J Surg 94:287–291

    Article  PubMed  CAS  Google Scholar 

  25. D’ Angelica M (2007) Radiofrequency-assisted hepatectomy may induce severe postoperative liver damage. World J Surg 31:2213–2214. doi:10.1007/s00268-007-9215-z

    Article  Google Scholar 

  26. Milicevic M, Bulajic P (2008) Radiofrequency-assisted liver resection does not induce severe liver damage. World J Surg 32:1901–1902. doi:10.1007/s00268-008-9665-y

    Article  PubMed  Google Scholar 

  27. Nishimura T, Nakahara M, Kobayashi S et al (1992) Ischemic injury in cirrhotic livers: an experimental study of the temporary arrest of hepatic circulation. J Surg Res 53:227–233

    Article  PubMed  CAS  Google Scholar 

  28. Jang JH, Moritz W, Graf R et al (2008) Preconditioning with death ligands fasL and TNF-α protects the cirrhotic mouse liver against ischaemic injury. Gut 57:492–499

    Article  PubMed  CAS  Google Scholar 

  29. van der Bilt JD, Kranenburg O, Nijkamp MW et al (2005) Ischemia/reperfusion accelerates the outgrowth of hepatic micrometastases in a highly standardized murine model. Hepatology 42:165–175

    Article  PubMed  Google Scholar 

  30. van der Bilt JD, Kranenburg O, Verheem A et al (2006) Selective portal clamping to minimize hepatic ischaemia-reperfusion damage and avoid accelerated outgrowth of experimental colorectal liver metastases. Br J Surg 93:1015–1022

    Article  PubMed  Google Scholar 

  31. Lesurtel M, Selzner M, Petrowsky H et al (2005) How should transection of the liver be performed?: a prospective randomized study in 100 consecutive patients: comparing four different transection strategies. Ann Surg 242:814–823

    Article  PubMed  Google Scholar 

  32. Ercolani G, Grazi GL, Ravaioli M et al (2003) Liver resection for HCC on cirrhosis: a univariate and multivariate analysis of risk factors for intrahepatic recurrence. Ann Surg 237:536–543

    PubMed  Google Scholar 

  33. Piscaglia F, Bolondi L (2010) The intermediate hepatocellular carcinoma stage: should treatment be expanded? Dig Liver Dis 42(Suppl):258–263

    Article  Google Scholar 

  34. Llovet JM, Bruix J (2008) Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol 48(Suppl 1):20–37

    Article  Google Scholar 

  35. Lammer J, Malagari K, Vogl T et al (2010) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33:41–52

    Article  PubMed  Google Scholar 

  36. Ho MC, Huang GT, Tsang YM et al (2009) Liver resection improves the survival of patients with multiple hepatocellular carcinomas. Ann Surg Oncol 16:848–855

    Article  PubMed  Google Scholar 

  37. Tiong L, Maddern GJ (2011) Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. BJS 98:1210–1224

    Article  CAS  Google Scholar 

  38. Kuroda S, Tashiro H, Kobayashi T et al (2011) Selection criteria for hepatectomy in patients with hepatocellular carcinoma classified as Child-Pugh class B. World J Surg 35:834–841. doi:10.1007/s00268-010-0929-y

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. First Surgical Clinic, Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia

    Danijel A. Galun, Predrag Bulajic, Marinko Zuvela, Dragan Basaric & Miroslav N. Milicevic

  2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Miroslav N. Milicevic

  3. Faculty of Medicine, Department for Biostatistics, Medical informatics, and Researches in Medicine, University of Belgrade, Belgrade, Serbia

    Tatjana Ille

Authors
  1. Danijel A. Galun
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  2. Predrag Bulajic
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  3. Marinko Zuvela
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  4. Dragan Basaric
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  5. Tatjana Ille
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  6. Miroslav N. Milicevic
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Correspondence to Danijel A. Galun.

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Galun, D.A., Bulajic, P., Zuvela, M. et al. Is There any Benefit from Expanding the Criteria for the Resection of Hepatocellular Carcinoma in Cirrhotic Liver? Experience from a Developing Country. World J Surg 36, 1657–1665 (2012). https://doi.org/10.1007/s00268-012-1544-x

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