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Clinical Outcomes for Hepatocellular Carcinoma

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Venous Embolization of the Liver

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Abstract

Hepatocellular carcinoma (HCC) patients with >3 cm and/or multiple lesions can only expect a prolonged survival if they are eligible for a surgical treatment, e.g., resection or liver transplantation. Liver transplantation is the best option as it cures both the HCC and the underlying disease and is therefore associated with a better disease-free survival than resection. Yet, liver transplantation is selectively indicated because of graft shortage and is being offered to a limited number of patients with the best oncological prognosis, those entering the Milan criteria. Liver resection in the setting of chronic liver disease is a risky procedure, which calls for a stringent selection and preparation of the patients before surgery. Besides the stage of the tumor, the selection process is mainly based on the evaluation of the liver function reserve and the liver volume. When the patients are not good candidates for a surgical treatment, transarterial chemoembolization (TACE) is the treatment of choice. Because TACE is associated with a longer survival than symptomatic treatment in palliative cares, TACE has been used as a neoadjuvant treatment before surgery in order to reduce the recurrence rate. To date, no data support its use prior to surgery in patients deemed resectable up-front, but by downsizing the tumor in good responders, nonresectable patients may become resectable. In patients with a borderline liver function, portal vein embolization (PVE) is used to increase the future liver remnant volume without compromising the prognosis. Although there is some theoretical reason to use PVE cautiously in HCC patients, published data indicates that PVE offers an extension of the indication of liver resection for HCC. Finally, to counterbalance the potential side effects of PVE in the setting of HCC, it was thought to use a sequential arterioportal approach as both procedures may be synergistic. TACE may enhance the impact of PVE on regeneration and PVE may enhance the anticancer effect of TACE. There are very few series evaluating this sequence and none are prospective but, to date, it seems to be the best preoperative option before liver resection in HCC patients.

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References

  1. Bosch FX, Ribes J, Diaz M, et al. Primary liver cancer: worldwide incidence and trends. Gastroenterology. 2004;127:S5-S16.

    Article  PubMed  Google Scholar 

  2. Belghiti J, Panis Y, Farges O, et al. Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg. 1991;214:114-117.

    Article  PubMed  CAS  Google Scholar 

  3. Nagasue N, Uchida M, Makino Y, et al. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology. 1993;105:488-494.

    Article  PubMed  CAS  Google Scholar 

  4. Takayasu K, Wakao F, Moriyama N, et al. Postresection recurrence of hepatocellular carcinoma treated by arterial embolization: analysis of prognostic factors. Hepatology. 1992;16:906-911.

    Article  PubMed  CAS  Google Scholar 

  5. Nonami T, Isshiki K, Katoh H, et al. The potential role of postoperative hepatic artery chemotherapy in patients with high-risk hepatomas. Ann Surg. 1991;213:222-226.

    Article  PubMed  CAS  Google Scholar 

  6. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693-699.

    Article  PubMed  CAS  Google Scholar 

  7. Okada S, Shimada K, Yamamoto J, et al. Predictive factors for postoperative recurrence of hepatocellular carcinoma. Gastroenterology. 1994;106:1618-1624.

    PubMed  CAS  Google Scholar 

  8. Vauthey JN, Lauwers GY, Esnaola NF, et al. Simplified staging for hepatocellular carcinoma. J Clin Oncol. 2002;20:1527-1536.

    Article  PubMed  Google Scholar 

  9. Chapman WC, Majella Doyle MB, Stuart JE, et al. Outcomes of neoadjuvant transarterial chemoembolization to downstage hepatocellular carcinoma before liver transplantation. Ann Surg. 2008;248:617-625.

    PubMed  Google Scholar 

  10. Belghiti J, Cortes A, Abdalla EK, et al. Resection prior to liver transplantation for hepatocellular carcinoma. Ann Surg. 2003;238:885-892. discussion 892–883.

    Article  PubMed  Google Scholar 

  11. Belghiti J. Resection of hepatocellular carcinoma complicating cirrhosis. Br J Surg. 1991;78:257-258.

    Article  PubMed  CAS  Google Scholar 

  12. Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26:1176-1181.

    PubMed  CAS  Google Scholar 

  13. Abulkhir A, Limongelli P, Healey AJ, et al. Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg. 2008;247:49-57.

    Article  PubMed  Google Scholar 

  14. Truty MJ, Vauthey JN. Uses and limitations of portal vein embolization for improving perioperative outcomes in hepatocellular carcinoma. Semin Oncol. 2010;37:102-109.

    Article  PubMed  Google Scholar 

  15. Lesurtel M, Mullhaupt B, Pestalozzi BC, et al. Transarterial chemoembolization as a bridge to liver transplantation for hepatocellular carcinoma: an evidence-based analysis. Am J Transplant. 2006;6:2644-2650.

    Article  PubMed  CAS  Google Scholar 

  16. Lewandowski RJ, Kulik LM, Riaz A, et al. A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant. 2009;9:1920-1928.

    Article  PubMed  CAS  Google Scholar 

  17. Zhou WP, Lai EC, Li AJ, et al. A prospective, randomized, controlled trial of preoperative transarterial chemoembolization for resectable large hepatocellular carcinoma. Ann Surg. 2009;249:195-202.

    Article  PubMed  Google Scholar 

  18. Zhang Z, Liu Q, He J, et al. The effect of preoperative transcatheter hepatic arterial chemoembolization on disease-free survival after hepatectomy for hepatocellular carcinoma. Cancer. 2000;89:2606-2612.

    Article  PubMed  CAS  Google Scholar 

  19. Wu CC, Ho YZ, Ho WL, et al. Preoperative transcatheter arterial chemoembolization for resectable large hepatocellular carcinoma: a reappraisal. Br J Surg. 1995;82:122-126.

    Article  PubMed  CAS  Google Scholar 

  20. Sasaki A, Iwashita Y, Shibata K, et al. Preoperative transcatheter arterial chemoembolization reduces long-term survival rate after hepatic resection for resectable hepatocellular carcinoma. Eur J Surg Oncol. 2006;32:773-779.

    Article  PubMed  CAS  Google Scholar 

  21. Paye F, Farges O, Dahmane M, et al. Cytolysis following chemoembolization for hepatocellular carcinoma. Br J Surg. 1999;86:176-180.

    Article  PubMed  CAS  Google Scholar 

  22. Majno PE, Adam R, Bismuth H, et al. Influence of preoperative transarterial lipiodol chemoembolization on resection and transplantation for hepatocellular carcinoma in patients with cirrhosis. Ann Surg. 1997;226:688-701. discussion 701–683.

    Article  PubMed  CAS  Google Scholar 

  23. Luo YQ, Wang Y, Chen H, et al. Influence of preoperative transcatheter arterial chemoembolization on liver resection in patients with resectable hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int. 2002;1:523-526.

    PubMed  Google Scholar 

  24. Hwang TL, Chen MF, Lee TY, et al. Resection of hepatocellular carcinoma after transcatheter arterial embolization. Reevaluation of the advantages and disadvantages of preoperative embolization. Arch Surg. 1987;122:756-759.

    Article  PubMed  CAS  Google Scholar 

  25. Harada T, Matsuo K, Inoue T, et al. Is preoperative hepatic arterial chemoembolization safe and effective for hepatocellular carcinoma? Ann Surg. 1996;224:4-9.

    Article  PubMed  CAS  Google Scholar 

  26. Gerunda GE, Neri D, Merenda R, et al. Role of transarterial chemoembolization before liver resection for hepatocarcinoma. Liver Transpl. 2000;6:619-626.

    Article  PubMed  CAS  Google Scholar 

  27. Choi GH, Kim DH, Kang CM, et al. Is preoperative transarterial chemoembolization needed for a resectable hepatocellular carcinoma? World J Surg. 2007;31:2370-2377.

    Article  PubMed  Google Scholar 

  28. Nagasue N, Galizia G, Kohno H, et al. Adverse effects of preoperative hepatic artery chemoembolization for resectable hepatocellular carcinoma: a retrospective comparison of 138 liver resections. Surgery. 1989;106:81-86.

    PubMed  CAS  Google Scholar 

  29. Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology. 2003;37:429-442.

    Article  PubMed  CAS  Google Scholar 

  30. Monden M, Okamura J, Sakon M, et al. Significance of transcatheter chemoembolization combined with surgical resection for hepatocellular carcinomas. Cancer Chemother Pharmacol. 1989;23(Suppl):S90-S95.

    Article  PubMed  Google Scholar 

  31. Shimamura Y, Gunven P, Takenaka Y, et al. Combined peripheral and central chemoembolization of liver tumors. Experience with lipiodol-doxorubicin and gelatin sponge (L-TAE). Cancer. 1988;61:238-242.

    Article  PubMed  CAS  Google Scholar 

  32. Paye F, Jagot P, Vilgrain V, et al. Preoperative chemoembolization of hepatocellular carcinoma: a comparative study. Arch Surg. 1998;133:767-772.

    Article  PubMed  CAS  Google Scholar 

  33. Shim JH, Kim KM, Lee YJ, et al. Complete necrosis after transarterial chemoembolization could predict prolonged survival in patients with recurrent intrahepatic hepatocellular carcinoma after curative resection. Ann Surg Oncol. 2010;17:869-877.

    Article  PubMed  Google Scholar 

  34. Adachi E, Matsumata T, Nishizaki T, et al. Effects of preoperative transcatheter hepatic arterial chemoembolization for hepatocellular carcinoma. The relationship between postoperative course and tumor necrosis. Cancer. 1993;72:3593-3598.

    Article  PubMed  CAS  Google Scholar 

  35. Liou TC, Shih SC, Kao CR, et al. Pulmonary metastasis of hepatocellular carcinoma associated with transarterial chemoembolization. J Hepatol. 1995;23:563-568.

    Article  PubMed  CAS  Google Scholar 

  36. Yu YQ, Xu DB, Zhou XD, et al. Experience with liver resection after hepatic arterial chemoembolization for hepatocellular carcinoma. Cancer. 1993;71:62-65.

    Article  PubMed  CAS  Google Scholar 

  37. Lau WY, Ho SK, Yu SC, et al. Salvage surgery following downstaging of unresectable hepatocellular carcinoma. Ann Surg. 2004;240:299-305.

    Article  PubMed  Google Scholar 

  38. Lau WY, Lai EC, Leung TW, et al. Adjuvant intra-arterial iodine-131-labeled lipiodol for resectable hepatocellular carcinoma: a prospective randomized trial-update on 5-year and 10-year survival. Ann Surg. 2008;247:43-48.

    Article  PubMed  Google Scholar 

  39. Garcea G, Maddern GJ. Liver failure after major hepatic resection. J Hepatobiliary Pancreat Surg. 2009;16:145-155.

    Article  PubMed  Google Scholar 

  40. Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107:521-527.

    PubMed  CAS  Google Scholar 

  41. de Baere T, Roche A, Elias D, et al. Preoperative portal vein embolization for extension of hepatectomy indications. Hepatology. 1996;24:1386-1391.

    Article  PubMed  Google Scholar 

  42. Yigitler C, Farges O, Kianmanesh R, et al. The small remnant liver after major liver resection: How common and how relevant? Liver Transpl. 2003;9:S18-S25.

    Article  PubMed  Google Scholar 

  43. Hemming AW, Reed AI, Howard RJ, et al. Preoperative portal vein embolization for extended hepatectomy. Ann Surg. 2003;237:686-691. discussion 691–683.

    PubMed  Google Scholar 

  44. Palavecino M, Chun YS, Madoff DC, et al. Major hepatic resection for hepatocellular carcinoma with or without portal vein embolization: perioperative outcome and survival. Surgery. 2009;145:399-405.

    Article  PubMed  Google Scholar 

  45. Seo DD, Lee HC, Jang MK, et al. Preoperative portal vein embolization and surgical resection in patients with hepatocellular carcinoma and small future liver remnant volume: comparison with transarterial chemoembolization. Ann Surg Oncol. 2007;14:3501-3509.

    Article  PubMed  Google Scholar 

  46. Chik BH, Liu CL, Fan ST, et al. Tumor size and operative risks of extended right-sided hepatic resection for hepatocellular carcinoma: implication for preoperative portal vein embolization. Arch Surg. 2007;142:63-69. discussion 69.

    Article  PubMed  Google Scholar 

  47. Wakabayashi H, Ishimura K, Okano K, et al. Is preoperative portal vein embolization effective in improving prognosis after major hepatic resection in patients with advanced-stage hepatocellular carcinoma? Cancer. 2001;92:2384-2390.

    Article  PubMed  CAS  Google Scholar 

  48. Tanaka H, Hirohashi K, Kubo S, et al. Preoperative portal vein embolization improves prognosis after right hepatectomy for hepatocellular carcinoma in patients with impaired hepatic function. Br J Surg. 2000;87:879-882.

    Article  PubMed  CAS  Google Scholar 

  49. Lee KC, Kinoshita H, Hirohashi K, et al. Extension of surgical indications for hepatocellular carcinoma by portal vein embolization. World J Surg. 1993;17:109-115.

    Article  PubMed  CAS  Google Scholar 

  50. Kinoshita H, Sakai K, Hirohashi K, et al. Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg. 1986;10:803-808.

    Article  PubMed  CAS  Google Scholar 

  51. Sugawara Y, Yamamoto J, Higashi H, et al. Preoperative portal embolization in patients with hepatocellular carcinoma. World J Surg. 2002;26:105-110.

    Article  PubMed  Google Scholar 

  52. Azoulay D, Castaing D, Krissat J, et al. Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver. Ann Surg. 2000;232:665-672.

    Article  PubMed  CAS  Google Scholar 

  53. Aoki T, Imamura H, Hasegawa K, et al. Sequential pre­operative arterial and portal venous embolizations in patients with hepatocellular carcinoma. Arch Surg. 2004;139:766-774.

    Article  PubMed  Google Scholar 

  54. Makuuchi M, Kosuge T, Lygidakis NJ. New possibilities for major liver surgery in patients with Klatskin tumors or primary hepatocellular carcinoma—an old problem revisited. Hepatogastroenterology. 1991;38:329-336.

    PubMed  CAS  Google Scholar 

  55. Ogata S, Belghiti J, Farges O, et al. Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma. Br J Surg. 2006;93:1091-1098.

    Article  PubMed  CAS  Google Scholar 

  56. Yamakado K, Takeda K, Matsumura K, et al. Regeneration of the un-embolized liver parenchyma following portal vein embolization. J Hepatol. 1997;27:871-880.

    Article  PubMed  CAS  Google Scholar 

  57. Yamakado K, Nakatsuka A, Tanaka N, et al. Long-term follow-up arterial chemoembolization combined with transportal ethanol injection used to treat hepatocellular carcinoma. J Vasc Interv Radiol. 1999;10:641-647.

    Article  PubMed  CAS  Google Scholar 

  58. Zalinski S, Scatton O, Randone B, et al. Complete hepatocellular carcinoma necrosis following sequential porto-arterial embolization. World J Gastroenterol. 2008;14:6869-6872.

    Article  PubMed  Google Scholar 

  59. Wallace MJ, Ahrar K, Madoff DC. Chemoembolization of the liver after portal vein embolization: report of three cases. J Vasc Interv Radiol. 2008;19:1513-1517.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Digestive and Hepatobiliary Surgery, Hôpital Saint-Antoine, Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France

    Stéphane Zalinski M.D.

  2. Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France

    Jacques Belghiti

Authors
  1. Stéphane Zalinski M.D.
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  2. Jacques Belghiti
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Correspondence to Jacques Belghiti .

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Editors and Affiliations

  1. New York-Presbyterian Hospital, New York, 10032, New York, USA

    David C. Madoff

  2. University of Tokyo, Hongo 7-3-1, Tokyo, 113-8656, Japan

    Masatoshi Makuuchi

  3. School of Medicine, Dept. Surgery I, Nagoya University, Tsurumai-cho 65, Nagoya, Aichi-ken, 466-8550, Japan

    Masato Nagino

  4. M.D. Anderson Cancer Center, Dept. Surgical Oncology, University of Texas, Holcombe Blvd. 1515, Houston, 77030, Texas, USA

    Jean-Nicolas Vauthey

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Zalinski, S., Belghiti, J. (2011). Clinical Outcomes for Hepatocellular Carcinoma. In: Madoff, D., Makuuchi, M., Nagino, M., Vauthey, JN. (eds) Venous Embolization of the Liver. Springer, London. https://doi.org/10.1007/978-1-84882-122-4_20

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  • DOI: https://doi.org/10.1007/978-1-84882-122-4_20

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