National Cancer Institute®
Last Modified: October 1, 2002
UI - 12174393
AU - Wu W; Lin XB; Qian JM; Ji ZL; Jiang Z
TI - Ultrasonic aspiration hepatectomy for 136 patients with hepatocellular carcinoma.
SO - World J Gastroenterol 2002 Aug;8(4):763-5
AD - Institute of Acoustics,Ultrasonic Medical Electronics Research Group State Key Laboratory of Modern Acoustics, Nanjing University, Nanjing 210093, Jiangsu Province, China. email@example.com
AIM:To study the operative injury, post-operative complications, the hospitalization time, the post-operative survival rate of ultrasonic aspiration hepatectomy with a domestic new type of ultrasonic surgical device in comparison with that of conventional techniques of hepatectomy. METHODS: A total 136 patients with hepatocellular carcinoma (HCC, including 12 patients in 1991 and 124 consecutive patients from resection (group T) and 179 HCC patients received conventional hepatectomy during the corresponding period (group C). The results of the two groups were compared statistically. RESULTS: There was no significant difference in the mean operation time between group T (152+/-11 min) and C (144+/-11 min). No operation or hospital death occurred in both groups. In group T, the mean volumes of bleeding (463+/-15 ml) and blood transfusion (381+/-12 ml) were markedly less than those in group C (557+/-20 ml, and 507+/-18 ml, respectively, P<0.05). The mean hospitalization time of group T (8.9+/-0.6 d) was markedly shorter than that of group C (11.7d+/-0.6 d) (P<0.05). The incidence of complications in group T was markedly lower than in group C, post-operative jaundice occurred in 4/136 and 31/179, respectively (P<0.05), liver failure in 0/136 and 2/179, cholorrhea in 0/136 and 6/179, hydrothorax in 21/136 and 39/179 (P<0.05), ascices in 9/136 and 54/179, respectively (P<0.05 ). There was no significant difference in the 1-year survival rate between the two groups (P>0.05), while the 3-year survival rate of group T (64.2 % ) increased markedly as compared with that of group C (55.7 %) (P<0.01). CONCLUSION: The ultrasonic aspiration hepatectomy with a domestic new type of ultrasonic surgical device could evidently reduce the operative injury and post-operative complications, shorten the hospitalization time and prolong the survivals of HCC patients.
UI - 12193853
AU - Roudot-Thoraval F; Dhumeaux D
TI - [Towards early screening and treatment of hepatocellular carcinoma cirrhosis?]
SO - Gastroenterol Clin Biol 2002 Jun-Jul;26(6-7):559-60
UI - 12193855
AU - Ganne-Carrie N; Chevret S; Barbare JC; Chaffaud C; Grando V; Vogt AM;
TI - Beaugrand M; Trinchet JC; et l'Association Francaise pour l'Etude du Foie (2) et l'Association Nationale des Gastroenterologues des Hopitaux generaux [Practical screening and early treatment of hepatocellular carcinoma. Results of a French survey]
SO - Gastroenterol Clin Biol 2002 Jun-Jul;26(6-7):570-7
AD - Service d'Hepato-Gastroenterologie, Hopital Jean Verdier (AP-HP, Universite Paris 13), Bondy 93140, France. firstname.lastname@example.org
AIM: To describe French practices for screening hepatocellular carcinoma. METHODS: A standardized questionnaire was mailed to all out of 623 practitioners responded (66%). 394 (96%) routinely screen hepatocellular carcinoma, mainly with ultrasound (98%) and mainly at 6-month intervals (77%). Screening was performed in cirrhosis (100%) or extensive fibrosis (54%), independent of the etiology (21%) or the Child-Pugh score of the chronic liver disease (41%), but based on age and treatment feasibility. If of a small hypoechogenic nodule was detected in a young patient with compensated HCV-cirrhosis, 59% of practitioners performed a histological examination. In case of non biopsy-proven hepatocellular carcinoma, a second biopsy (49%), treatment (either percutaneous alcohol injection, resection or transplantation) (24%) or an ultrasonographic follow-up (23%) was proposed. In case of biopsy-proven hepatocellular carcinoma, resection (49%), transplantation (30%) or percutaneous alcohol injection (16%) was proposed. CONCLUSION: Almost all French specialists routinely screen cirrhotic patients for hepatocellular carcinoma, but use somewhat different modalities. In case of small HCC without contraindications to curative treatment, surgical resection is performed in half the patients.
UI - 12211740
AU - Szubert A; Sarzynski J; Biejat Z; Uryzek M; Grous A; Kowalik I; Polanski
TI - JA Risk factors for morbidity following liver surgery.
SO - Med Sci Monit 2001 May;7 Suppl 1():294-7
AD - 3rd Department of Surgery, 2nd Faculty of Medicine, Medical University in Warsaw, ul. Stepinska 19/25, Warsaw, Poland.
The aim of this study is to define risk factors for severe complications following anatomical liver resections. The study material consists of the first 50 patients (26 women, 24 men, at mean age 50.6 years) treated at 3rd Department of Surgery 2nd Faculty of Medicine, Medical University in Warsaw. The indications for resection included benign neoplasm in 19 cases and malignancy in 31 cases. All the patients underwent anatomical liver resection in accordance with Couinaund's segmental division. In order to define prognostic factors for severe postoperative complications, a multi-factor statistical analysis was conducted. The following parameters were analysed: patient's age, the levels of bilirubin, total protein, albumin, prothrombin time, kaolin-kephalin time, range of resection and blood loss during operation. Eleven patients (22%) died in postoperative period. In 8 cases the death was caused by liver failure. Statistical analysis showed that blood loss, albumin level on fifth postoperative day and kaolin-kephalin time before and after surgery are independent risk factors predisposing to the development of complications.
UI - 12211741
AU - Szubert A; Zajac L; Walski M; Faryna M; Biejat Z; Polanski J
TI - Liver regeneration after anatomical resections.
SO - Med Sci Monit 2001 May;7 Suppl 1():298-300
AD - 3rd Department of Surgery, 2nd Faculty of Medicine, Medical University in Warsaw, ul. Stepinska 19/25, Warsaw, Poland.
BACKGROUND: The authors present the results of investigation of liver regeneration after partial parenchyma resection. MATERIAL AND METHODS: 20 patients (16 females, 4 male) aged 31-67 years were operated on because of metastatic colon cancer (7 cases), cavernous hemangioma (6 cases), hepatocellular carcinoma (1), alveococcosis (2), metastases of malignant melanoma (1), gall bladder carcinoma (1), FNH (1) and mucous cystadenocarcinoma (1). The resection according to anatomical segments by Couinaud were performed. Spiral CTs including liver volumetry were taken before and 30 days after the operation. on the 7-th day after the surgery, liver biopsy was performed and the material was examined under light and electron microscope. RESULTS: There was no postoperative mortality. We observed transient elevation of transaminases, bilirubin levels and decrease of albumin level. Control spiral CT revealed increased liver volume in 15 cases (75 percent). In 16 cases (80 percent), electron microscopy investigations showed regeneration of the liver (mitotic figures). CONCLUSIONS: Our material shows that hyperplasia as well as blood vessel and bile duct neogenesis play a very important role in liver regeneration process.
UI - 3001424
AU - Gonzalez F; Marks C
TI - Hepatic tumors and oral contraceptives: surgical management.
SO - J Surg Oncol 1985 Jul;29(3):193-7
The clinical and pathological features of 14 patients with benign liver tumors are reviewed. There were two males and 12 females in this series of cases. All but one of the females had been on contraceptive steroid therapy for an average of 7.8 years. Abdominal pain was the presenting complaint in 75% of cases, a palpable abdominal mass was present in 22%, while 12.5% of the patients presented with acute hemorrhagic shock due to rupture of a liver cell adenoma. Liver cell adenomas (LCA) were found in 87.5% of the cases and a diagnosis of focal nodular hyperplasia (FNA) was made at histologic examination of the resected tumors in 12.5% of cases. Surgical resection of the liver tumors was performed successfully in 89% of the cases. Hepatic lobectomy was accomplished in four patients, hepatic segmentectomy was possible in three cases, while local wedge resection or focal excision were indicated on seven occasions. There was no operative mortality in this series, but one patient required reoperation for drainage of a complicating subphrenic abscess.
UI - 2461847
AU - Habscheid W
TI - [Hepatocellular carcinoma]
SO - Dtsch Med Wochenschr 1988 Dec 9;113(49):1926-31
AD - Medizinische Universitatsklinik Wurzburg.
UI - 11941934
AU - Colombo M; Sangiovanni A
TI - The European approach to hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):12-6
AD - Division of Hepatology, IRCCS Maggiore Hospital, University of Milan, Milan, Italy. email@example.com
Patients with cirrhosis of viral, metabolic or autoimmune origin are at high risk of developing hepatocellular carcinoma. Prospective surveillance based on semi-annual ultrasound examination of the abdomen has allowed for detection of small tumors in many patients, but it is not clear whether liver-related mortality was decreased in parallel. Prognostication in patients with hepatocellular carcinoma requires integrated assessment of tumor size and number, liver function and performance status. The therapeutic approach is to a large extent non-evidence based and the best treatment choice depends on individual patients characteristics, taking into account the local technological and therapeutic resources and skills. Since surgical resection, liver transplantation and percutaneous ablation have achieved a high rate of complete response in properly selected patients, these procedures are considered curative treatments. Being curative treatments applicable only to patients with a small tumor, hepatocellular carcinoma surveillance aimed at early detection of the tumor is the most practical approach for improving treatment outcome.
UI - 11941945
AU - Fan ST
TI - Methods and related drawbacks in the estimation of surgical risks in cirrhotic patients undergoing hepatectomy.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):17-20
AD - Department of Surgery, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong. firstname.lastname@example.org
There has been a dramatic improvement in recent results of hepatectomy for hepatocellular carcinoma in cirrhotic patients. Hospital mortality rates of less than 5% are frequently reported. The improvement is largely a result of better techniques and performance of surgeons in hepatectomy, and reduction in blood loss and transfusion requirement. Better selection of patients is perhaps a more significant contributory factor. Careful identification of risk factors related to the medical condition of the patient, functional reserve of the liver and volume of the remnant liver is essential for the prevention of postoperative liver failure. Indocyanine green clearance test is the most accurate test for assessment of liver function reserve. An indocyanine green retention rate of 14% at 15 minutes is the safety limit for major hepatectomy for cirrhotic patients. A maximum of 60% of the nontumorous liver can be resected safely. Computed tomography is therefore an important assessment parameter. The liver function reserve also reveals the suitability for hepatectomy. Liver enzymes, alanine aminotransferase or aspartate aminotransferase can reflect the hepatic activity, which could be responsible for the impaired liver function. Steatosis is another factor that influences hepatic function reserve. Age is also an important risk factor in hepatectomy because elderly patients may harbor occult heart disease, reduced respiratory and liver function reserves. After recognizing the risk factors, surgeons should eliminate operative morbidity and mortality by making appropriate decisions based on the assessments. In conclusion, preoperative risk assessment involves evaluation of hepatic function reserve, remnant liver volume, liver status, age and the medical condition of the patient. A 0% hospital mortality rate is considered the objective.
UI - 11941957
AU - Torzilli G; Leoni P; Gendarini A; Calliada F; Olivari N; Makuuchi M
TI - Ultrasound-guided liver resections for hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):21-7
AD - Liver Surgery Unit, Reparto di Chirurgia Generale 1 Ospedale Maggiore di Lodi, Azienda Sanitaria Locale della Provincia di Lodi Largo Donatori di Sangue, 2, I-26900, Lodi, Italy. email@example.com
Imaging-guided interventional procedures have modified the approach to hepatocellular carcinoma including the surgical one. In fact, liver resections can be carried out with no mortality even if cirrhosis is associated, combining the needs for oncological radicality and liver parenchyma sparing mainly because of the extensive use of intraoperative ultrasonography either for tumor staging or resection-guidance. The aid of intraoperative ultrasonography is therefore optimizing the balance between the oncological radicality and the sparing of the highest amount of functioning liver parenchyma. Intraoperative ultrasonography allows the accomplishment of anatomical resections otherwise not possible such as the systematic segmentectomy. This is of crucial importance if taking into account that anatomical resections seem able to provide better prognosis than the non-anatomical one. However, if non-anatomical resection is carried out intraoperative ultrasonography guidance allows a better tumor clearance. Precise definition of hepatic vein anatomy and association with color Doppler enables hepatectomies otherwise not possible, expanding the indication at surgical resection. In conclusion, we can affirm that liver resection is an imaging-guided procedure and as every interventional imaging-guided procedure, its features are the highest therapeutic efficacy combined with the minimal invasiveness. Then, with the intraoperative ultrasonography guidance liver resection remains the treatment of choice of hepatocellular carcinoma.
UI - 11941979
AU - Pocard M; Sauvanet A; Regimbeau JM; Duwat O; Farges O; Belghiti J
TI - Limits and benefits of exclusive transthoracic hepatectomy approach for patients with hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):32-5
AD - Department of Digestive Surgery, Hopital Beaujon, Clichy, France.
BACKGROUND/AIMS: The purpose of this study was to evaluate the results of liver resection in cirrhotic patients for liver hepatocellular carcinoma located near the diaphragm through an exclusive transthoracic approach. METHODOLOGY: Between 1995 and 1999, 19 cirrhotic patients with hepatocellular carcinoma underwent a liver resection through an exclusive transthoracic approach. This approach was indicated in 11 cases for previous upper abdominal surgery, including hepatobiliary surgery in 3 and before liver transplantation in 8. Results of the transthoracic approach were compared to 84 cirrhotic patients who underwent transabdominal limited resection of hepatocellular carcinoma matched for age, sex and localization of the tumor. RESULTS: Resection was feasible by an exclusive transthoracic approach in 18 (95%) cases with a mean operating time of 201 +/- 53 min. In 8 (44%) patients a Pringle maneuver was performed. No postoperative deaths were observed after the transthoracic approach. Pulmonary complications rate was significantly higher (P < 0.001) after transthoracic resection compared to transabdominal resection (67% vs. 25%, P < 0.001). In contrast, ascites were observed in only one (5%) of the transthoracic group compared to 35 (42%) in the transabdominal group (P < 0.01). The resection margin was positive in 3 (17%) after transthoracic approch and in 1 (2%) patient after the transabdominal resection (P < 0.02). In patients who underwent liver transplantation after the transthoracic approach, total hepatectomy was performed without increasing difficulties. CONCLUSIONS: The transthoracic approach is a safe procedure for resection of hepatocellular carcinoma located under the right diaphragm in cirrhotic patients. However, this approach allows only limited resection with a high risk of positive margin, resulting in a restriction of indications either for patients with previous major abdominal surgery than before liver transplantation.
UI - 11941980
AU - Makuuchi M
TI - Remodeling the surgical approach to hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):36-40
AD - Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033. firstname.lastname@example.org
Surgery for hepatocellular carcinoma has improved during the last two decades, and the improvement is mainly attributable to various innovations in liver surgery, such as establishment of the precise criteria for surgical indications, development of ultrasound-guided hepatectomy, and additional use of portal vein embolization. Operative mortality has fallen below 2% in the 1990's, and the 5-year survival rate reached, according to the results of a nationwide survey, nearly 50%. More than 90% of the hepatectomies in the authors' institution are performed without whole blood transfusion, and mean hospital stay is approximately 23 days. Moreover, no-mortality hepatectomy has been achieved since 1993.
UI - 11941981
AU - Belghiti J; Regimbeau JM; Durand F; Kianmanesh AR; Dondero F; Terris B;
TI - Sauvanet A; Farges O; Degos F Resection of hepatocellular carcinoma: a European experience on 328 cases.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):41-6
AD - Department of Hepatobiliary and Digestive Surgery, Beaujon Hospital, Paris VII University, Clichy, France. email@example.com
BACKGROUND/AIMS: Surgical liver resection has been demonstrated in Asian countries to be the best therapeutic option in patients with hepatocellular carcinoma. Because the value of this treatment is still debated in Western countries, the aim of this paper was to report a European experience of resection for hepatocellular carcinoma. METHODOLOGY: From 1990 to 1999, 239 men and 61 women aged from 15 to 77 years old underwent 328 resections including major resection in 138 (42%) cases. Normal liver was present in 53 patients (17%) and chronic liver disease was present in 247 including 152 (50%) with cirrhosis. RESULTS: In-hospital mortality was 6.4% and was significantly influenced by the presence of chronic liver disease (1.7% vs. 7.4%). Mortality after resection in alcoholic patients (14%), in patients with hepatitis C (9%) was significantly higher than in patients chronic hepatitis B (1%) (P < 0.05). The overall survival rates were 81%, 57%, 37%, and 13% at 1, 3, 5 and 10 years. Five-year survival rate was significantly higher (P < 0.05) in patients with normal liver as compared to chronic liver disease (50% vs. 34%). In patients with chronic liver disease parameters, which significantly influenced survival rate, were vascular invasion, tumor differentiation and the extent of resection. CONCLUSIONS: In this European study with varied profile of etiologies associated with hepatocellular carcinoma we showed that a five-year survival rate of 40% can be expected after resection and that chronic liver disease is a major factor influencing short and long-term prognosis.
UI - 11941982
AU - Durand F; Belghiti J
TI - Liver transplantation for hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):47-52
AD - Department of Hepatology, Hopital Beaujon, Clichy, France.
Liver transplantation has become the best option in patients with decompensated cirrhosis and a small hepatocellular carcinoma. Indeed, because of the severity of cirrhosis, resection is usually impossible and in addition, transplantation provides survival rates close to those obtained in cirrhotic patients without malignancy (70 to 80% 3-year survival rate). In patients with a small hepatocellular carcinoma and compensated cirrhosis, both resection and transplantation can be performed. Because of the scarcity of donors, there have been reservations concerning transplantation in patients who otherwise could have undergone resection. However, there is increasing evidence that long-term results of transplantation are significantly superior to those of resection. Therefore, patients with a small hepatocellular carcinoma and compensated cirrhosis are increasingly considered as suitable candidates for transplantation. In contrast to cirrhotic patients with a small hepatocellular carcinoma, patients with large and/or multifocal tumors should no longer be transplanted because of a high rate of early recurrence and the accelerated course of tumor progression due to immunosuppression, both factors being the source of poor results. On rare occasions, hepatocellular carcinoma develops in patients without underlying liver disease. In such cases the tumor is usually recognized when it is large and symptomatic. The absence of underlying liver lesions offers the possibility of extended resection. However, in case of nonresectable (bilobar) tumors or limited recurrence after resection, transplantation may be considered due to the slow progression this subtype of hepatocellular carcinoma. Whatever the underlying liver parenchymal status, efforts should be made to reduce the risk of recurrence.
UI - 11941983
AU - Makuuchi M; Belghiti J; Torzilli G
TI - Reasons for an exchange between eastern and western approach to patients with HCC.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):5-6
UI - 12356006
AU - Anonymous
TI - Hepatocellular Carcinoma: Eastern and Western Experiences. Proceedings of an international congress. Tokyo, Japan, December 9, 2000.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):5-95
UI - 11941985
AU - Montorsi M; Santambrogio R; Bianchi P; Dapri G; Spinelli A; Podda M
TI - Perspectives and drawbacks of minimally invasive surgery for hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):56-61
AD - Department of Surgery, University of Milan, Ospedale S. Paolo, Milano, Italy. firstname.lastname@example.org
The need for an accurate intrahepatic staging is crucial for patients with hepatocellular carcinoma candidates to an aggressive surgical or ablative treatment. Currently available data indicate that laparoscopy with laparoscopic ultrasound provides information similar to that obtained by intraoperative ultrasound and it is able to identify small intrahepatic lesions not diagnosed by preoperative imaging techniques. Furthermore, laparoscopy with laparoscopic ultrasound also allows performance of ultrasound-guided biopsies or interstitial therapies as ethanol injection, cryoablation or radiofrequency thermal ablation in the same session. A laparoscopic segmentectomy or subsegmentectomy is technically feasible and safe in selected patients with small peripheral tumors. Combinations of resection and ablation may be required in certain cases, extending the indications for the laparoscopic approach to hepatocellular carcinoma in liver cirrhosis. The AA review the technical issues and the preliminary results of their experience in the field of minimally invasive approach to hepatocellular carcinoma. On the basis of these preliminary findings, laparoscopy with laparoscopic ultrasound seems to be useful to identify unsuspected new nodules and to help in choosing the most suitable treatment. In case of hepatocellular carcinoma not amenable to surgical resection, laparoscopic radiofrequency represents a safe and effective treatment above all when the percutaneous approach is difficult or impossible. Furthermore, laparoscopy with laparoscopic ultrasound could represent a sound preliminary examination in patients who are candidates to liver transplantation in order both to improve the staging and to guide an interstitial therapy as a bridge to the transplantation itself.
UI - 11941986
AU - Livraghi T; Meloni F
TI - Treatment of hepatocellular carcinoma by percutaneous interventional methods.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):62-71
AD - Department of Radiology, Ospedale Civile, via Cereda 23, 20059 Vimercate, Milan, Italy. email@example.com
In the treatment of early and intermediate hepatocellular carcinoma the range of indications for percutaneous ablation techniques is becoming wider than surgery or intra-arterial therapies. Indeed, whereas for some years only patients with up to three small tumors were treated, with the introduction of the single-session technique performed under general anesthesia, even patients with more advanced disease are now being treated. Although it is understood that partial resection assures the highest local control, the survival rates after surgery are roughly comparable with percutaneous ethanol injection. The explanation is due to a balance among advantages and disadvantages of the two therapies. Percutaneous ethanol injection survival curves are better than curves of resected patients who present adverse prognostic factors, and this means that surgery needs a better selection of the patients. Indications for both of these therapies are reported. An open question remains about the choice between percutaneous ethanol injection and other new ablation procedures. In our department we currently use radiofrequency ablation in the majority of patients but consider percutaneous ethanol injection and segmental transarterial chemoembolization complementary, and use them according to the features of the disease and the response. Evaluation of their therapeutic efficacy, techniques and results are reported.
UI - 11941987
AU - Llovet JM; Fuster J; Bruix J
TI - Prognosis of hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):7-11
AD - Barcelona-Clinic Liver Cancer (BCLC) Group, Liver Unit, Institut de Malalties Digestives, Hospital Clinic Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Catalonia, Spain.
The prognosis of patients with hepatocellular carcinoma is related to the stage of the tumor at diagnosis and to the degree of liver function impairment induced either by the tumor itself or by the underlying cirrhosis. Any prognostic prediction should also take into account the potential impact of therapeutic interventions. Only surgical resection, liver transplantation and percutaneous ablation achieve a relatively high rate of complete responses in patients with tumors diagnosed at an early stage and may improve survival. By contrast, patients diagnosed at an advanced stage will receive palliative treatment with unproven survival benefits. Each stage and each treatment have their specific prognostic predictors. Thus, the most accurate prognostic system will have to use a specific model for each strata at which patients may be diagnosed: early, intermediate-advanced and terminal. Patients at an early stage may achieve a 5-year survival rate above 50%, those at intermediate-advanced present a 20-50% survival at 3 years and those at terminal stage die within six months. In addition to predicting prognosis, the staging system should also guide the selection of treatment and this is the major advantage of the classification applied in the Barcelona-Clinic Liver Cancer Group.
UI - 11941988
AU - Higashihara H; Okazaki M
TI - Transcatheter arterial chemoembolization of hepatocellular carcinoma: a Japanese experience.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):72-8
AD - Department of Radiology, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan. firstname.lastname@example.org
Hepatocellular carcinoma is one of the most common causes of cancer death in Japan and in 80% of cases is associated with chronic liver disease caused by hepatitis C virus. Poor hepatic function reserve due to underlying cirrhosis is the primary factor which limits extended surgical resection in many cases. Furthermore, in patients treated by curative resection, high incidence of recurrent tumors or/and newly developed tumor in the residual liver was reported. Therefore, the aim of various therapeutic options such as operation, percutaneous ethanol injection, radiofrequency coagulation therapy and transcatheter arterial chemoembolization should be the local control of hepatocellular carcinoma. Transcatheter hepatic arterial chemoembolization has a main role for the multidisciplinary treatment for hepatocellular carcinoma with this biological behavior.
UI - 11941989
AU - Carr BI
TI - Hepatic artery chemoembolization for advanced stage HCC: experience of 650 patients.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):79-86
AD - Liver Cancer Center, Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA. email@example.com
Hepatic artery chemotherapy using cisplatin in various protocols was examined in 650 patients. Overall objective tumor response rate (PR) was 65%. Average survival was 7.5 mo in patients with tumor progression, 18.0 mo for tumor stability and 32.0 mo for PR. 1- and 2-yr survival was 70% and 40% in responders, 20% and 0% in progressors. Prognostic factors were examined in 155 patients treated with cisplatin and gelfoam chemo-occlusion. In survival groups of > 24 mo, 4-24 mo and < 4 mo, similar numbers had cirrhosis, hepatitis B virus, hepatitis C virus and alcoholism. Decreased survival was associated with abnormal bilirubin, albumin and prothrombin time. Tumor vascularity and response to chemotherapy were associated with prolonged survival. Tumor vascularity seemed important for tumor response. Portal vein thrombosis occurred in all groups. Lesion number, bilobarity and maximum size had no correlation with response or survival. We analyzed the cause of death in 425 patients. No evidence of hepatocellular carcinoma progression, judged by absence of change in CT scan or tumor marker in the last 4 months of life, was found in 42%. A group of 57 patients were treated with cisplatin in dose range 125-200 mg/m2 alone or with gelfoam. In both groups, responders survived longer than non-responders: cisplatin alone responder mean survival, 29.0 mo, non-responder 11.1 mo, P < 0.0001. There was a strong effect of dose density on median survival for cisplatin alone, but not for cisplatin and gelfoam. CONCLUSIONS: A large experience of single-agent cisplatin chemo-occlusion is summarized. Good liver function and tumor vascularity are associated with response to chemotherapy, which in turn is associated with enhanced survival. Many deaths are due to cirrhosis and not hepatocellular carcinoma.
UI - 11941990
AU - Takayama T; Makuuchi M
TI - Prevention of hepatocellular carcinoma recurrence: actuality and perspectives.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):87-90
AD - Third Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-machi, Itabashi-ku, Tokyo 173-8610, Japan. firstname.lastname@example.org
Postsurgical recurrence of hepatocellular carcinoma is frequent and fatal. Various adjuvant treatments to possibly prevent recurrence have been recommended, which seem to depend on expectation rather than evidence. Up to now, randomized controlled trials have been conducted to clarify the clinical effect of the 4 therapeutic options including acyclic retinoid, 131I-lipiodol, adoptive immunotherapy, and interferon. We have recently demonstrated that adoptive immunotherapy is a safe, feasible treatment that can reduce the risk of recurrence and improve recurrence-free outcomes. Actually all the options reduced in part the recurrence but had drawbacks in the their effectiveness, and large trials are needed to assess other important endpoints, such as clinical feasibility, risk-benefit and cost-effectiveness. Recurrence control of hepatocellular carcinoma is the clinical priority, and we are approaching this goal.
UI - 12161910
AU - Voirin D; Payan Y; Amavizca M; Letoublon C; Troccaz J
TI - Computer-aided hepatic tumour ablation: requirements and preliminary results.
SO - C R Biol 2002 Apr;325(4):309-19
AD - Laboratoire TIMC, faculte de medecine, domaine de la Merci, 38706 La Tronche, France.
Surgical resection of hepatic tumours is not always possible, since it depends on different factors, among which their location inside the liver functional segments. Alternative techniques consist in local use of chemical or physical agents to destroy the tumour. Radio frequency and cryosurgical ablations are examples of such alternative techniques that may be performed percutaneously. This requires a precise localisation of the tumour placement during ablation. Computer-assisted surgery tools may be used in conjunction with these new ablation techniques to improve the therapeutic efficiency, whilst they benefit from minimal invasiveness. This paper introduces the principles of a system for computer-assisted hepatic tumour ablation and describes preliminary experiments focusing on data registration evaluation. To keep close to conventional protocols, we consider registration of pre-operative CT or MRI data to intra-operative echographic data.
UI - 12113666
AU - Ye S
TI - [Present status and evaluation of interventional therapy for primary hepatocellular carcinoma]
SO - Zhonghua Gan Zang Bing Za Zhi 2002 Jun;10(3):165-6
AD - Liver Cancer Institute, Fudan University, Shanghai 200032, China.
UI - 12113667
AU - Guo W; Yu E; Yi C; Wu W; Lin J
TI - [Prognostic factors influencing survival in patients with large hepatocellular carcinoma receiving combined transcatheter arterial chemoembolization and radiotherapy]
SO - Zhonghua Gan Zang Bing Za Zhi 2002 Jun;10(3):167-9
AD - Oncology Department of Cancer Center, Xinhua Hospital of Shanghai Second Medical University, Shanghai 200092, China.
OBJECTIVE: To observe the long-term effects of combined transcatheter arterial chemoembolization (TACE) and radiotherapy for patients with large hepatocellular carcinoma (HCC) and to analyze the prognostic factors. METHODS: A total of 107 patients with large unresectable HCC (the largest diameter of tumor ranged from 5 to 18 cm) were treated with TACE followed by external-beam irradiation. Acute effects and survival rates were observed. The Cox proportional hazards model was used to analyze the prognostic factors. RESULTS: An objective response was achieved in 48.6% of the cases. The cumulative survival rates at 1, 3, and 5 years were 59.4%, 28.4%, and 15.8%, respectively. The tumor number and irradiation dose were the independent prognostic factors. The cumulative survival rates of the patients with a solitary lesion (75.8%, 43.9%, and 26.8% at 1, 3, and 5 years, respectively) were significantly higher than those with multiple lesions (31.3%, and 5.0% at 1 and 3 years, respectively, P=0.0005). The survival rates of the patients received irradiation above 40 Gy (95.8%, 74.7%, and 37.4% at 1, 3, and 5 years, respectively) were significantly higher than those received 20~40 Gy (60.9%, 20.7%, and 10.3%, respectively) and those received radiation lower than 20 Gy (26.7%, 7.1%, and 7.1%, respectively, P=0.0001). CONCLUSIONS: Combined TACE with radiotherapy is a promising treatment for large unresectable HCC. The number of tumor is the most important clinical prognostic factor. Delivering the highest irradiation dose within the tolerance of the liver is the key to improve the long-term effect.
UI - 12113669
AU - Li C; Xu D; Xu D; Li X; Zhang W; Liu Y
TI - [Hyperthermal lipiodol embolization and thermocoagulation for the treatment of primary hepatocellular carcinoma]
SO - Zhonghua Gan Zang Bing Za Zhi 2002 Jun;10(3):174-6
AD - Ditan Hospital, Beijing 100011, China.
OBJECTIVE: To explore the efficacy of hyperthermal lipiodol embolization and thermocoagulation for the treatment of primary hepatocellular carcinoma. METHODS: One hundred and thirty-one cases were randomized into two groups: the hyperthermal dilute lipiodol embolization group (63 cases) and the chemoembolization group (68 cases). With Seldinger's method, We first placed the catheter to the targeting vessel superselectively and then put the hyperthermal dilute lipiodol (110 degrees C) 10~30ml to the tumor vessels to IV degree for the former group; gave the lipiodol-epirubicin emulsion by the same way to the latter group. RESULTS: The rate of tumor minification and AFP normalization in the hyperthermal lipiodol embolization group was higher than that in the lipiodol-epirubicin embolization group. The side effects and the liver damage were mild in the former group. The survival time of the patients in the former group was longer than that in the latter group. CONCLUSIONS: Embolization of the tumor vessels with hyperthermal dilute lipiodol is more thorough due to its better fluidity. The thermocoagulation of the hyperthermal dilute lipiodol becomes stronger for its higher specific heat. It is therefore a good technique for the treatment of primary hepatocellular carcinoma.
UI - 12202976
AU - Rossi S; Garbagnati F; Rosa L; Azzaretti A; Belloni G; Quaretti P
TI - Radiofrequency thermal ablation for treatment of hepatocellular carcinoma.
SO - Int J Clin Oncol 2002 Aug;7(4):225-35
AD - Operative Unit for Liver Cancer Diseases, Policlinico S. Matteo IRCCS, Piaz.le Golgi no.1, 27100, Pavia, Italy. email@example.com
UI - 12071454
AU - Rindani RB; Hugh TJ; Roche J; Roach PJ; Smith RC
TI - 131I lipiodol therapy for unresectable hepatocellular carcinoma.
SO - ANZ J Surg 2002 Mar;72(3):210-4
AD - Department of Surgery, The University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
BACKGROUND: More than 80% of hepatocellular carcinoma tumours (HCC) are unresectable at presentation because of the multicentric nature of the disease or the severity of liver disease. Arterially administered lipiodol is preferentially retained by HCC and has been used as a vehicle for delivery of therapeutic agents to the tumour. The aim of this phase I study is to present the experience with 131I-labelled lipiodol in the treatment of unresectable HCC. METHODS: 131Iodine lipiodol treatment was administered to 12 patients with unresectable HCC between 1994 and 1999. The outcome of treatment in these patients was evaluated for survival, clinical tolerance, liver function tests, alpha-fetoprotein (AFP) levels and changes in tumour size on computed tomography (CT) scans. RESULTS: Ten of the 12 patients received more than one 131I treatment. Five patients had treatment for post-resection recurrence. Serum AFP levels dropped initially in five of the seven patients with elevated values. Tumour size, evaluated by CT scans at 3 months, decreased in six patients and remained stable in the rest, except one patient in whom both the AFP level and tumour size had increased. Using life table analysis, the 50% survival was 19 months. CONCLUSIONS: Intra-arterial 131I treatment was very well tolerated. A reduction in AFP levels and tumour size occurred in half of the patients and resulted in a 50% probability of survival of 19 months. Further examination of the value of this treatment in phase II and III studies is required.
UI - 12228902
AU - Perilongo G; Dall'Igna P; Sainati L
TI - Modern treatment of childhood hepatoblastoma: what do clinicians and pathologists have to say to each other?
SO - Med Pediatr Oncol 2002 Nov;39(5):474-7
AD - Division of Haematology-Oncology, Department of Paediatrics, University-Hospital of Padova, Padova, Italy. firstname.lastname@example.org
UI - 12228904
AU - Finegold MJ
TI - Chemotherapy for suspected hepatoblastoma without efforts at surgical resection is a bad practice.
SO - Med Pediatr Oncol 2002 Nov;39(5):484-6
AD - Department of Pathology, Texas Children's Hospital, Houston, Texas 77030, USA. email@example.com
BACKGROUND: US and European practices differ with respect to treating hepatoblastoma (HB). Should chemotherapy be given prior to resection in all cases, and even without biopsy confirmation (SIOPEL)? PROCEDURE AND RESULTS: US data indicate that 40% of HBs are primarily resectable with no operative mortality and that those with pure fetal histology and low mitotic rate do not require toxic chemotherapy. They also suggest that those with a significant fraction of small undifferentiated cells do not respond to otherwise effective chemotherapy. Both US and European studies report a significant error rate in the clinical and imaging diagnosis of HB. CONCLUSIONS: Although only 6.5% of confirmed HBs fall into categories that would be managed differently by US standards, there is no justification for denying those patients a more appropriate treatment nor should the 6-10% of cases that are misdiagnosed as HB be treated incorrectly. Copyright 2002 Wiley-Liss, Inc.
UI - 11783240
AU - Liu C; Cai Y; Huang Z
TI - [Clinical study on effect of Chinese herbal medicine on liver damage caused by hepatic artery chemoembolization]
SO - Zhongguo Zhong Xi Yi Jie He Za Zhi 1999 May;19(5):276-8
AD - Zhaoqing Municipal Hospital of TCM, Guangdong (526020).
OBJECTIVE: To observe the effect of Chinese herbal medicine on hepatic artery chemoembolization caused liver damage. METHODS: One hundred and ten patients, who received hepatic artery chemoembolization, were divided into two groups, 60 patients in the treated group were treated with Qinggan Jiedu Sanjie Decoction and the other 50 Patients in the control group treated with routine western medicine. The changes of liver function, cirrhosis incidence and exacerbation rate of both groups were observed. RESULTS: The total liver function deterioration rate of the treated group, according to Child's grading standard, was 46.67%, while that of the control group was 68.00%, the former was much lower than the latter (P < 0.05). The cirrhosis incidence and exacerbation rate in the treated group were 35.00% (7/20) and 50.00% (20/40) respectively, while in the control group, they were 65.00% (13/20) and 76.67% (23/30) respectively. The difference between the two groups was also significant (P < 0.05). CONCLUSION: Qinggan Jiedu Sanjie Decoction has some effect on alleviating and preventing hepatic damage caused by hepatic artery chemoembolization.
UI - 12354601
AU - Kamada K; Kitamoto M; Aikata H; Kawakami Y; Kono H; Imamura M; Nakanishi
TI - T; Chayama K Combination of transcatheter arterial chemoembolization using cisplatin-lipiodol suspension and percutaneous ethanol injection for treatment of advanced small hepatocellular carcinoma.
SO - Am J Surg 2002 Sep;184(3):284-90
AD - First Department of Internal Medicine, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima City, Hiroshima, Japan. firstname.lastname@example.org
BACKGROUND: We evaluated the long-term efficacy of the combination of transcatheter arterial chemoembolization (TACE) using cisplatin-lipiodol suspension and percutaneous ethanol injection (PEI) for treatment of advanced small hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Sixty-nine patients with HCC less than 3 cm in diameter and at most three lesions were enrolled in this study. HCC nodules were confirmed to be hypervascular by angiography. Thirty-two patients were treated with a combination of TACE and PEI (TACE/PEI group) and 37 patients with TACE alone (TACE group). RESULTS: The 5-year survival rates were 50% for the TACE/PEI group and 22% for the TACE group. The TACE/PEI group had a slightly but not significantly better survival than the TACE group. The 5-year survival rates of patients with solitary HCC were 61% for the TACE/PEI group and 24% for the TACE group. Although the two therapeutic groups both had high rates of recurrence, the rates in the TACE/PEI group were significantly lower than those in the TACE group (P <0.05). Severe complications such as intraperitoneal bleeding and segmental hepatic infarction were observed at low incidence, and recovered with supportive treatment. CONCLUSIONS: The combination of TACE and PEI appears to prolong survival, compared with TACE alone. This combination therapy can thus be a valuable form of treatment for unresectable advanced small HCC.
UI - 12352881
AU - Srinivasan P; McCall J; Pritchard J; Dhawan A; Baker A; Vergani GM;
TI - Muiesan P; Rela M; David Heaton N Orthotopic liver transplantation for unresectable hepatoblastoma.
SO - Transplantation 2002 Sep 15;74(5):652-5
AD - Liver Transplant Surgical Service, Institute of Liver Studies, London, UK.
BACKGROUND: The outcome of treatment for advanced hepatoblastoma has recently improved after the introduction of preoperative or pre- and postoperative cisplatin-containing chemotherapy combined with complete surgical excision. The role of liver transplantation in a population of patients who have received this regimen has not been clearly defined. METHODS: Orthotopic liver transplantation (OLT) was performed in 13 children, aged 5 months to 11 years (median 27 months), who were assessed with unresectable hepatoblastoma, and whose pretreatment extent-of-disease was based on radiologic findings