ABSTRACT
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. At present, hepatectomy is one of the most frequent therapeutic options, whereas the high postoperative recurrence rate severely affects the long-term survival of HCC patients. Therefore, it is urgent to choose appropriate therapeutic regime to treat the recurrence of HCC to improve the long-term survival of HCC patients. Surgical treatment is an efficacious treatment for recurrent HCC, including re-hepatectomy, salvage liver transplantation and radiofrequency ablation. Currently, individualized treatment is recommended for postoperative recurrence of HCC. The selection of treatment should be conducted based on the tumor conditions after the first hepatectomy, the characteristics of recurrent tumors, baseline data of patients and recurrence time, etc., aiming to formulate appropriate treatment regimes for patients. In this article, these surgical regimes were reviewed and compared to explore appropriate surgical schemes for postoperative recurrence of HCC, aiming to provide reference for prolonging the survival of HCC patients.
ABSTRACT
Objective:To compare the prognoses of salvage liver transplantation fulfilling the Criteria of Milan, University of California San Francisco(UCSF)and Hangzhou.Methods:Clinical data were retrospectively reviewed for 256 patients with recurrent hepatocellular carcinoma(HCC)undergoing donation after citizen death(DCD)liver transplantation(LT)from January 2015 to October 2019.They were divided into two groups of primary(PLT, n=175)and salvage(SLT, n=81). General profiles, tumor pathological characteristics and postoperative complications of two groups were compared by T-test, rank-sum or χ2 test.Kaplan-Meier method and Log rank test were employed for comparing overall survival rate(OS)and recurrence-free survival rate(RFS)between two groups.In SLT group, 31 cases fulfilled Milan criteria, 45 cases UCSF criteria and 69 cases Hangzhou criteria.OS/RFS of three groups were compared.According to there was downstaging or bridging treatment pre-LT, SLT group was divided into downstaging group(n=32)and non-downstaging group(n=49). OS/RFS of two groups were compared.According to the Rescit1.1 criteria, downstaging group were divided into remission group(n=14)and non-remission group(n=18)and OS/RFS of two groups were compared. Results:The operative durations of PLT and SLT groups were(439.5±74.9)and(475.1±83.4)min respectively.There was significant inter-group difference( P<0.05); However, no significant inter-group difference existed in amount of intraoperative bleeding, blood transfusion, postoperative hospital stay or incidence of postoperative complications(all P>0.05). No significant difference existed in OS/RFS between PLT and SLT groups( P>0.05). No significant difference existed in OS at 1/3/5 years post-SLT among Milan, UCSF and Hangzhou criteria groups(all P>0.05); However, RFS in Milan criteria group at 1/3/5 years post-SLT were 93.5%, 81.7% and 81.7% respectively.They were significantly higher than 68.9%, 59.7% and 59.7% in UCSF criteria group and 78.3%, 58.8% and 55.5% in Hangzhou criteria group(all P<0.05). For patients on downstaging therapy, OS in the Remission group at 1, 3 and 5 years post-SLT were 100%, 73% and 73% respectively, which was significantly higher than 83.3%, 49.4% and 0 in non-Remission group( P=0.042). RFS in the Remission group at 1, 3 and 5 years post-SLT were 100%, 62.5% and 46.9% respectively, which was significantly higher than 52.9%, 0 and 0 in no-Remission group( P=0.001). Conclusions:The survival outcome of SLT recipients is similar to that of PLT recipients.The overall survival of SLT recipients shows no significant difference between Milan, UCSF and Hangzhou criteria.However, SLT recipients fulfilling Milan criteria have the longest recurrence-free time.The prognosis of patients with remission after preoperative descending treatment is superior to that of patients without remission.
ABSTRACT
Liver surgery such as hepatectomy and liver transplantation are curative treatment options for selected hepatocellular carcinoma(HCC) patients. The concept of salvage liver transplantation(SLT) was proposed,due to the shortage of liver donors. In the case of donor liver shortage,HCC patients underwent liver resection first and liver transplantation after tumor recurrence or deteriorating liver function. The timing,criteria,efficacy and influencing factors of SLT operation are still improving and developing in overworld transplantation centers. Primary liver transplantation was the first choice for the HCC patients with portal hypertension,severe cirrhosis and poor liver function reserve. Primary hepatectomy should be performed for HCC patients with good liver function and resectable tumor,followed with combined treatment to delay tumor progression and strict follow-up. And then SLT is feasible for patients with tumor recurrence and meeting the criteria of liver transplantation with or without downstage treatment.
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For recurrent hepatocellular carcinoma(HCC),hepatectomy is an active and active treatment method.Choosing appropriate cases will get good results. RecurrentHCC complies with Milan criteria,ECOG score is 0-2,andsalvage liver transplantation(SLT) can be considered. If thediameter of the tumor is less than 5 cm,single or multiplelesions are concentrated in a certain area,located at the edgeof the liver,and the liver function is good,hepatectomy should be the first choice. Laparoscopic surgery may also beconsidered in units with good equipment and accumulatedexperience. For recurrent HCC with tumor diameter > 5 cm,aslong as liver reserve function is allowed and FRLV issufficient,it should be actively strived for resection again. If ithas been proved that recurrent HCC originated from a singlecenter or combined with MVI,comprehensive treatment shouldbe rationally arranged. Besides hepatectomy,RFA,TACE,TACE + RFA and targeted drugs should be sequentiallycombined. Otherwise,the effect of hepatectomy alone is notideal. If recurrent HCC is accompanied by decompensation ofliver function,severe cirrhosis,portal hypertension,andinvasion of the main intrahepatic vascular trunk,it isrecommended to abandon reoperation and adopt other non-surgical treatment.
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Objective To evaluate the curative effect of salvage liver transplantation and repeated hepatectomy for recurrent hepatocel-lular carcinoma.Methods The data of 72 patients with recurrent hepatocellular carcinoma fulfilling Child-Pugh A and the Milan criteria from September 2004 to August 2010 were retrospectively studied.According to different treatments,53 patients were divided into repeated hepatec-tomy group,and 19 patients were divided into salvage liver transplantation group.The overall survival rates and disease-free survival rates after operation were evaluated by Kaplan-Meier method.COX proportional hazard was used for univariate analysis and multivariate analysis to eval-uate the risk factors for prognosis.Results The 1-year,3-year and 5-year survival rates were 86.79%,62.26% and 45.28% in repeated hepatectomy group,and 89.47%,68.42%and 57.89% in the salvage liver transplantation group respectively.There was no significant differ-ence in the overall survival rates between the two groups (χ2 =2.530,P =0.112).The 1-year,3-year and 5-year disease-free survival rates were 67.92%,47.17% and 35.85%in the repeated hepatectomy group,94.74%,68.42% and 52.63% in the salvage liver transplantation group respectively.There was a significant difference in the disease-free survival rates between the two groups(χ2 =4.395,P =0.036).The univariate analysis and multivariate analysis indicated that microvascular invasion,satellite lesion and multiple tumors were the independent risk factors to influence the survival.Conclusion The salvage liver transplantation obtains a better effect for the patients fulfilling Child-Pugh A and the Milan criteria,which is an effective method in the treatment of hepatocellular carcinoma.
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Purpose: Liver transplantation has been performed for recurrent hepatocellular carcinoma (HCC) or deterioration of liver function after prior primary liver resection. Prior major liver resection per se is an unfavorable condition for living donor liver transplantation (LDLT). We analyzed the technical feasibility of prior major hepatectomy-graft combinations for salvage LDLT. Methods: Of the 17 patients who underwent salvage LDLT, 5 underwent prior major liver resection. Results: Two patients with prior left lobectomy received right lobe graft, whereas, of the 3 patients with prior right lobectomy, 2 received right lobe graft and 1 received left lobe graft. During recipient hepatectomy, it was necessary to perform meticulous sharp dissection of the previous liver cut surface to attain full mobilization. Different methods of hepatic vein reconstruction were applied after the recipient inferior vena cava was fully dissected. Reconstruction of the portal vein, hepatic artery and bile duct were performed on case by case basis depending on the remnant hilar structures. Conclusion: In conclusion, every combination of recipient prior right or left lobectomy and living donor right or left liver graft seems to be feasible for salvage LDLT.