Search

Background: Systemic inflammatory response represented by C‐reactive protein and albumin ratio (CAR) and modified albumin‐bilirubin (mALBI) grade both have been associated with long‐term outcome in patients with hepatocellular carcinoma (HCC). In this study, we investigated the prognostic utility of combined score of CAR and mALBI score to predict the prognosis of HCC patients after hepatic resection. Methods: This study included 214 patients who had undergone primary hepatic resection for HCC between 2008 and 2018. Systemic inflammatory response and mALBI were evaluated preoperatively and patients were classified into three groups based on the combination of CAR and mALBI score: low CAR and low mALBI grade (score 0), either high CAR or high mALBI grade (score 1), and both high CAR and high mALBI grade ≥2b (score 2). Multivariate Cox proportional hazard models were conducted to assess disease‐free and overall survival. Results: In multivariate analysis, sex (p < 0.01), HBsAg positivity (p < 0.01), serum AFP level ≥20 ng/mL (p < 0.01), microvascular invasion (p = 0.02), multiple tumors (p < 0.01), type of resection (p < 0.01), and CAR‐mALBI score ≥2 (HR 2.19, 95% CI 1.39–3.44, p < 0.01) were independent prognostic factors of disease‐free survival, while sex (p = 0.01), HBsAg positivity (p < 0.01), poor tumor differentiation (p = 0.03), multiple tumors (p < 0.01), CAR‐mALBI score ≥2 (HR 2.70, 95% CI 1.51–4.83, p < 0.01) were independent prognostic factors of overall survival. Conclusions: CAR‐mALBI score is associated with disease‐free and overall survival in patients with HCC after hepatic resection, suggesting the importance of evaluating both hepatic functional reserve and host‐inflammatory state in the risk assessment of HCC patients. [ABSTRACT FROM AUTHOR]

Aim: A recent study reported the utility of the definition of malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria in many types of cancers and chronic inflammatory disease. The present retrospective study aimed to investigate the significance of malnutrition defined with GLIM criteria in patients with hepatic resection for hepatocellular carcinoma (HCC) and also to compare malnutrition using handgrip strength. Methods: We retrospectively reviewed data from 174 patients who had undergone curative hepatic resection for HCC including both skeletal muscle area and handgrip strength. Patients were divided according to malnutrition defined by GLIM or modified GLIM and clinicopathologic and short‐ and long‐term outcomes were analyzed. The modified GLIM criteria was defined using both handgrip strength and skeletal muscle area. Results: Malnutrition defined by GLIM criteria was diagnosed in 47 patients (26.7%) and malnutrition defined by modified GLIM criteria was diagnosed in 21 patients (11.9%). Malnutrition defined by GLIM or modified GLIM criteria was associated with poorer liver function and malignant tumor behavior, but modified GLIM criteria predicted the postoperative complication and recurrence‐free survival outcome independently. In patients with poor liver function, malnutrition defined by modified GLIM criteria predicted postoperative complication and overall and recurrence‐free survival. Conclusions: Malnutrition defined by modified GLIM criteria using both handgrip strength and skeletal muscle area can more accurately predict short‐ and long‐term outcomes compared to malnutrition defined by the GLIM criteria. Nutritional and exercise therapy could become more important in patients with malnutrition and poor liver function. [ABSTRACT FROM AUTHOR]

Background: The techniques involved in neonatal and infantile transplantation require approaches that can sculpt a left lateral segment (LLS) to the right shape and size and avoid large‐for‐size syndrome. The aim of this article is to describe the anterior hepatic resection (AHR) of the LLS in pediatric LDLT. Methods: A retrospective anatomical study of preoperative image studies, description of the technique for AHR, and short‐term results. Results: The AHR was performed in eight cases. All donors were male, with average age, BW, and BMI of 28.3 ± 5.9 years, 74.2 ± 9.3 kg, and 24.3 ± 2.6 kg/m2, respectively. Donors were discharged at an average of 3.6 ± 0.8 days. The median recipient age and BW at transplantation were 6.9 (2.7 to 11) months and 5.9 (3.9 to 8) kg, respectively, and the recipient‐to‐donor body weight ratio (RDBW) was <0.1 in all but one case. The mean percentage reduction in graft weight and in the antero‐posterior diameter were 33.2% ± 5.5% and 38.3% ± 12.6%, respectively. The average (SD) GRWR was 4.8% ± 1.7% before all the resections and 3.5% ± 1.0% after the procedures. Seven patients were primarily closed. Conclusion: After LLS resection, a nonanatomical anterior resection of the LLS was accomplished without hilar vascular dissection to segments II/III. The final liver graft allowed primary abdominal wall closure in all but one patient, with meaningful adjustments in GRWR. AHR proved to be simple, safe, reproducible, and effective in the presented case series. [ABSTRACT FROM AUTHOR]

Background and Aims: Extrahepatic recurrence (EHR) is one of the major reasons for the poor prognosis of hepatocellular carcinoma (HCC). The present study aimed to develop and assess the performance of predictive models by using a combination of presurgical circulating tumor cell (CTCs) data and clinicopathological features to screen patients at high risk of EHR to achieve precise decision‐making. Patients and Methods: A total of 227 patients with recurrent HCC and preoperative CTC data from January 2014 to August 2019 were enrolled. All patients were randomly assigned to one of two cohorts: development or validation. Two preoperative and postoperative nomogram models for EHR prediction were developed and multi‐dimensionally validated. Results: Patients with EHR had generally lower recurrence‐free survival (p < 0.001), and overall survival (p < 0.001), and significantly higher CTC counts (epithelial CTCs, epithelial/mesenchymal hybrid CTCs, and mesenchymal CTCs count, all p < 0.05) than those without EHR. Univariate and multivariate analyses revealed that EHR was associated with four risk factors in the development cohort: total CTC count (p = 0.014), tumor size (p = 0.028), node number (p = 0.045), and microvascular invasion (p = 0.035). These factors were incorporated into two nomogram models (preoperative and postoperative), which reliably predicted EHR through multidimensional verification (e.g., calibration plot, receiver operating characteristic analysis, decision curve analysis, and clinical impact curve analysis) in the development and validation cohorts, respectively. With threshold of scores of 100.3 and 176.8 before and after surgery respectively, both nomograms were able to stratify patients into two distinct prognostic subgroups (all p < 0.05). Conclusion: The present study proposed two nomogram models integrating presurgical CTC counts and clinicopathological risks and showed relatively good predictive performance of EHR, which may be beneficial to the clinical practice of HCC recurrence. Further multicenter studies are needed to assess its general applicability. [ABSTRACT FROM AUTHOR]

Background: The surgical indications and therapeutic strategies for early‐stage multifocal and recurrent hepatocellular carcinoma (rHCC) remain controversial. This study compared the long‐term outcome of patients with recurrent and multifocal HCC meeting the Barcelona Clinic Liver Cancer (BCLC) stage A with repeat hepatectomy (RH) and RH combined with intraoperative radiofrequency ablation (RFA). Methods: A total of 109 consecutive patients with intrahepatic early‐stage multifocal rHCC within BCLC stage A following RH or RH + RFA were retrospectively collected from April 2010 to May 2020. Propensity score matching, subgroup analysis, and univariate and multivariate analyses were performed. Overall survival after recurrence (rOS) and recurrence‐free survival after recurrence (rRFS) were calculated by Kaplan–Meier analysis. Results: The 1‐, 3‐, and 5‐year rOS and rRFS of the combination group and the RH group were similar (p =.699; p =.587, respectively). The similar results also appeared in matched population. Subgroup analyses indicated that there was no significant difference between patients with two tumors and three tumors, but the RH group was associated with better rRFS than the combination group for patients whose tumors were located in the same lobe (p =.045). Multivariate analysis revealed that time to recurrence (TTR) ≤ 2 years and intrahepatic metastasis (IM) pathologically were independent risk factors. Conclusions: For multifocal rHCC patients meeting the BCLC stage A, tumor which is difficult to be surgically resected could be treated by RFA in order to avoid complications or bleeding. Tumors which were located in the same lobe may be more suitable to be treated by RH alone. [ABSTRACT FROM AUTHOR]

Background: Frailty, represented by sarcopenia and osteopenia, has been associated with worse survival after hepatectomy in patients with hepatocellular carcinoma. Recently, the concept and term "osteosarcopenia" have been proposed, which has been associated with worse outcome in several malignancies. Methods: This study included 227 patients who underwent elective hepatic resection for hepatocellular carcinoma. Osteopenia was evaluated with computed tomographic measurement of pixel density in the midvertebral core of the 11th thoracic vertebra. The skeletal muscle index (SMI) was evaluated with psoas muscle areas at the third lumbar vertebra. Osteosarcopenia was defined as the concomitant occurrence of osteopenia and low SMI. We retrospectively investigated the relationship between osteosarcopenia and disease‐free and overall survival. Results: Osteosarcopenia was identified in 27 (12%) of the patients. Multivariate analysis showed that osteosarcopenia (P <.001), C‐reactive protein‐to‐albumin ratio ≥0.02 (P =.002), and stage ≥III (P ≤.001) were independent predictors of disease‐free survival, while osteosarcopenia (P <.001), Child‐Pugh grade B (P =.002), C‐reactive protein‐to‐albumin ratio ≥0.02 (P =.001), low SMI (P ≤.001), and stage ≥III (P ≤.001) were independent predictors of overall survival. Conclusion: Preoperative osteosarcopenia may be a prognostic factor in patients with hepatocellular carcinoma after hepatic resection. Our results suggests that the preoperative maintenance of skeletal muscle and bone density may potentially improve prognosis. [ABSTRACT FROM AUTHOR]

Background and Objectives: Previous studies have reported that the microvascular invasion three‐tiered grading (MiVI‐TTG) scheme is a better prognostic predictor than the two‐tiered microvascular invasion (MiVI) grading scheme in hepatocellular carcinoma. This study aims to explore the prognostic significance of MiVI‐TTG in patients undergoing liver resection for combined hepatocellular‐cholangiocarcinoma (cHCC) and to explore the risk factors for MiVI in cHCC. Methods: This research included 208 patients graded as M0, M1, or M2 using the MiVI‐TTG scheme. Predictive performance was assessed by Cox regression analysis, Kaplan–Meier curve with Log rank test, Harrell's c‐index, and time‐dependent areas under the receiver operating characteristic curve (tdAUC). The clinical utility of the two schemes was evaluated by decision cure analysis (DCA). The risk factors for MiVI were evaluated using logistic regression analysis. Results: Among 208 cHCC patients, the proportions of M0, M1 and M2 were 38.9%, 36.5%, and 24.5%, respectively. Patients with severe MiVI status had worse recurrence‐free survival and overall survival (OS) based on Kaplan–Meier analysis. M1, M2, and MiVI‐positive were independent risk factors for early recurrence, while M2 and MiVI‐positive were associated with overall survival (OS). MiVI‐TTG had a larger c‐index, tdAUC, and net benefit rate than the two‐tiered MiVI grading scheme for predicting recurrence free survival and OS. AFP≥400 ng/ml was the independent risk factor for MiVI, and satellite nodules were independent risk factors for M2. Conclusions: MiVI‐TTG has a greater prognostic value than the two‐tiered MiVI grading scheme in patients undergoing hepatic resection for cHCC. [ABSTRACT FROM AUTHOR]

The incidence rate of hepatocellular carcinoma (HCC) is expected to increase, with most cases occurring in Asia. In some parts of Asia, the occurrence of HCC developing from metabolic-related liver disease has markedly increased in recent years, whereas the occurrence of HCC developing from viral-hepatitis-related liver disease has decreased. Advancements in the treatment of HCC over the past few decades has been remarkable, with most treatment strategies to remove or control liver tumours (hepatic resection, local ablation, radiation therapy, transarterial chemoembolisation, hepatic arterial infusion chemotherapy) primarily developing in Asia. In addition, recent progress in systemic therapies has prolonged the prognosis of advanced HCC. Nowadays, six regimens of systemic therapies have become available in most countries, according to phase III trials (atezolizumab plus bevacizumab, sorafenib, lenvatinib, regorafenib, cabozantinib and ramucirumab). In a global randomised phase III trial (IMbrave 150 trial), the most effective of the latest drug designs was newly emerged combination immunotherapy (atezolizumab plus bevacizumab), which has shown significantly prolonged overall survival compared with sorafenib, which was the first-line systemic therapy for more than a decade. Now, the treatment dynamics for HCC are undergoing a major transition as a result of two important changes: the replacement of viral-related HCC by metabolic-related HCC and the emergence of combination immune therapy. [ABSTRACT FROM AUTHOR]

The incidence rate of hepatocellular carcinoma (HCC) is expected to increase, with most cases occurring in Asia. In some parts of Asia, the occurrence of HCC developing from metabolic‐related liver disease has markedly increased in recent years, whereas the occurrence of HCC developing from viral‐hepatitis–related liver disease has decreased. Advancements in the treatment of HCC over the past few decades has been remarkable, with most treatment strategies to remove or control liver tumours (hepatic resection, local ablation, radiation therapy, transarterial chemoembolisation, hepatic arterial infusion chemotherapy) primarily developing in Asia. In addition, recent progress in systemic therapies has prolonged the prognosis of advanced HCC. Nowadays, six regimens of systemic therapies have become available in most countries, according to phase III trials (atezolizumab plus bevacizumab, sorafenib, lenvatinib, regorafenib, cabozantinib and ramucirumab). In a global randomised phase III trial (IMbrave 150 trial), the most effective of the latest drug designs was newly emerged combination immunotherapy (atezolizumab plus bevacizumab), which has shown significantly prolonged overall survival compared with sorafenib, which was the first‐line systemic therapy for more than a decade. Now, the treatment dynamics for HCC are undergoing a major transition as a result of two important changes: the replacement of viral‐related HCC by metabolic‐related HCC and the emergence of combination immune therapy. [ABSTRACT FROM AUTHOR]

An 81‐year‐old man initially underwent right hepatic lobectomy for liver cancer and was pathologically diagnosed with combined hepatocellular and cholangiocarcinoma (CHC). At 13 months after resection, multiple lymph node metastases were observed. We started atezolizumab plus bevacizumab (Atez/Bev), achieving a 7.5‐month progression‐free survival. Atez/Bev might exhibit efficacy for CHC patients. [ABSTRACT FROM AUTHOR]

Aim: The prognostic impact of postoperative systemic inflammatory response using an intra/post‐operative prognostic scoring system in patients with colorectal liver metastases (CRLM) after hepatic resection had never been investigated previously. Methods: In total, 149 patients who underwent hepatic resection for CRLM were analyzed retrospectively. Intra/post‐operative prognostic scoring was performed using the postoperative modified Glasgow Prognostic Score (mGPS) at the first visit, after discharge, or a month after surgery during hospitalization. We investigated the association between clinicopathologic variables and disease‐free survival or overall survival by univariate and multivariate analyses. Results: The median evaluation period of postoperative mGPS was 30 (26‐36) days after hepatectomy. Seventy‐one patients (48%) were classified as postoperative day 30 mGPS 1 or 2. In multivariate analysis, an extrahepatic lesion (P =.02), multiple tumors (P =.05), and postoperative day 30 mGPS 1 or 2 (P <.01) were independent and significant predictors of disease‐free survival. Moreover, extrahepatic lesion (P =.04), and postoperative day 30 mGPS 1 or 2 (P =.02) were independent and significant predictors for overall survival. Patients with postoperative day 30 mGPS 1 or 2 had significantly more advanced tumors, more invasive surgery, and more chances of infectious postoperative complications than those with postoperative day 30 mGPS 0. Conclusion: Postoperative systemic inflammatory response, as evidenced by intra/post‐operative prognostic scoring system using postoperative day 30 mGPS, was a strong predictor for outcomes in patients who underwent liver resection for CRLM. [ABSTRACT FROM AUTHOR]

Background and Aim: Portal vein embolization (PVE) prior to hepatic resection reduces the risk of hepatic insufficiency in the postoperative period by redistributing blood from the embolized unhealthy liver to the healthy liver, termed the functional liver remnant (FLR). A retrospective analysis of liver volumes after embolization in a single institution was performed to identify change in volume of the FLR and determine factors affecting this change. Methods: Between 2013 and 2015, 21 patients undergoing PVE followed by hepatic resection for varied indications (colorectal metastases, hepatocellular carcinoma, cholangiocarcinoma, etc.) were included in this study. n‐butyl cyanoacrylate glue diluted with Lipiodol (35–45% strength) along with 75–100 μm of polyvinyl alcohol particles were used for embolization. Liver volumetric determination was performed before and after PVE and volume changes in the FLR were analyzed. Biochemical factors and factors affecting FLR hypertrophy were also analyzed. Results: Majority of the patients (n = 18) underwent right‐lobe embolization. All were performed using the ipsilateral approach. No major complications occurred with only one patient developing post‐procedural ascites requiring percutaneous draining. A significant increase in the mean volume of the FLR by 63.7% ± 91.6%, P = 0.001 was noted after PVE. The FLR/total liver volume (TLV) increased significantly by 17% ± 18%. No significant demographic factors affected FLR hypertrophy and no significant biochemical changes were noted. Thirteen patients were successfully operated on after embolization. Conclusions: PVE is effective in inducing significant hypertrophy of the future FLR, prior to hepatic resection in our institution. [ABSTRACT FROM AUTHOR]

Background and Aim: The aim of this study was to evaluate whether presence of varices on computed tomography (CT) could predict treatment outcome for hepatocellular carcinoma patients. Methods: We enrolled 241 patients with single hepatocellular carcinoma ≤ 5 cm treated by surgery. With the use of preoperative CT/endoscopy, patients were classified into the following: presence of standard clinically significant portal hypertension (CSPH) surrogate, defined as varices on esophagogastroduodenoscopy and/or thrombocytopenia with splenomegaly (group 1, n = 47); varices on CT without standard CSPH surrogate (group 2, n = 45); and none of both (group 3, n = 149). Development of posthepatectomy liver failure and overall survival (OS) were evaluated for each patient group, and patients were re‐classified into two groups according to presence of CT‐enhanced CSPH surrogate, defined as standard surrogate and/or varices on CT. Predictive power of each survival model was compared using Harrell's C‐index. Results: Posthepatectomy liver failure rate in group 2 was similar to that in group 1 (53.3% [24/45] vs. 55.3% [26/47]; P = 1.000) but significantly higher than that in group 3 (53.3% [24/45] vs. 28.2% [42/149], P = 0.002). Seven‐year OS rates in group 2 were similar to those in group 1 (55.6% vs. 60.8%, P = 0.988) but significantly lower than those in group 3 (55.6% vs. 83.3%, P = 0.001). Presence of standard CSPH surrogate (hazard ratio = 1.89 [1.08–3.30], P = 0.025) and CT‐enhanced CSPH surrogate (hazard ratio = 2.60 [1.56–4.39], P < 0.001) were significant predicting factor for OS. However, CT‐enhanced CSPH surrogate had significantly higher Harrell's C‐index than standard surrogate (0.619 vs. 0.553, P = 0.034). Conclusion: The presence of CT‐enhanced CSPH surrogate including varices on CT was the significant predictive of poor OS, providing better predictive power than standard surrogate. [ABSTRACT FROM AUTHOR]

Background and Aim: Prognosis of infiltrative hepatocellular carcinoma (iHCC) is poor, and the treatments selection based on efficacy is unclear. We performed this multicenter study to compare the efficacy of hepatic resection and transarterial chemoembolization (TACE) in treating patients with iHCC. Methods: We retrospectively analyzed the overall survivals (OS) in 319 patients with iHCC who were initially treated by hepatic resection (n = 133) or TACE (n = 186) at four tertiary centers. Fifty‐eight patients in the TACE group were assessed as resectable and compared with the hepatic resection group in subgroup analysis. A propensity score matched (PSM) analysis was performed to reduce selection bias. Cox regression was performed to identify significant factors associated with OS. Results: The median OS time was significantly longer in the hepatic resection group than that in the TACE group, before and after PSM (before PSM, 17.5 vs 7.3 months, P < 0.0001; after PSM, 14.0 vs 7.3 months, P < 0.0001). The multivariable analysis indicated TACE as a risk factor of OS (hazard ratio = 2.233, 95% confidence interval = 1.492 to 3.341, P < 0.0001), as well as portal venous tumor thrombosis grades 3–4 and alpha fetal protein (AFP) > 400 ng/mL. In the subgroup analysis, the better efficacy of hepatic resection over TACE persisted regardless of the grade of portal venous tumor thrombosis and the level of AFP. As for resectable patients, hepatic resection still showed significant survival benefit (before PSM, 17.5 vs 11.2 months, P = 0.0013; after PSM, 14.0 vs 10.9 months, P = 0.0304). Conclusion: Hepatic resection might be the better choice for patients with iHCC due to its better survival benefit than TACE. [ABSTRACT FROM AUTHOR]

Background/Purpose: To investigate the long‐term outcome and entire treatment course of patients with technically unresectable CRLM who underwent conversion hepatectomy and to examine factors associated with conversion to hepatectomy. Methods: Recurrence and survival data with long‐term follow‐up were analyzed in the cohort of a multi‐institutional phase II trial for technically unresectable colorectal liver metastases (the BECK study). Results: A total of 22/12 patients with K‐RAS wild‐type/mutant tumors were treated with mFOLFOX6 + cetuximab/bevacizumab. The conversion R0/1 hepatectomy rate was significantly higher in left‐sided primary tumors than in right‐sided tumors (75.0% vs 30.0%, P =.022). The median follow‐up was 72.6 months. The 5‐year overall survival (OS) rate in the entire cohort was 48.1%. In patients who underwent R0/1 hepatectomy (n = 21), the 5‐year RFS rate and OS rate were 19.1% and 66.3%, respectively. At the final follow‐up, seven patients had no evidence of disease, five were alive with disease, and 20 had died from their original cancer. All 16 patients who achieved 5‐year survival underwent conversion hepatectomy, and 11 of them underwent further resection for other recurrences (median: 2, range: 1‐4). Conclusions: Conversion hepatectomy achieved a similar long‐term survival to the results of previous studies in initially resectable patients, although many of them experienced several post‐hepatectomy recurrences. Left‐sided primary was found to be the predictor for conversion hepatectomy. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor and constitutes a major health threat globally. Intermediate HCC (Barcelona Clinic Liver Cancer Staging, stage B) encompasses a wide range of patients and is characterized by substantial heterogeneity with varying tumor burdens and liver functions. Therefore, it is paramount to evaluate the patient's overall conditions and to select the most appropriate therapy based on available evidence. Transarterial chemoembolization is the recommended first‐line therapy for intermediate HCC patients. However, in clinical practice, other treatment options are also used as alternative therapies, such as hepatic resection, percutaneous thermal ablation, radiotherapy (RT), systemic treatment, immunotherapy, and so forth. In this review, we will introduce current treatment strategies for intermediate HCC, discuss their advantages and disadvantages, and propose future directions. [ABSTRACT FROM AUTHOR]

Background: Percutaneous radiofrequency ablation (RFA) is used as a first‐line treatment for colorectal liver metastases that recur after first liver resection in our institution. We aim to evaluate its therapeutic efficacy compared to repeated surgical resection. Methods: A retrospective review was performed in 104 patients treated with curative intent for resectable recurrent colorectal liver metastases. Results: Sixty‐one patients underwent RFA and 43 patients underwent surgery. The overall recurrence rates were 82% in the RFA group and 65.1% in the resection group (P = 0.05). The local recurrence rate on a lesion‐basis was markedly higher after RFA than that after resection (16.7% versus 7.3%, P = 0.04). The difference remained significant in patients with a maximum lesion diameter >3 cm (24.5% versus 7.6%, P = 0.01). RFA treatment was independently associated with recurrence on multivariate analyses (P = 0.01). 69.7% of RFA patients and 42.6% of surgery patients with intrahepatic recurrence were amenable to repeated local treatment (P = 0.05), leading to the equivalent actuarial 3‐year progression free survival rates (RFA: 29.1% versus Resection: 33.1%, P = 0.48) and 5‐year overall survival rates in the two treatment groups (RFA: 33% versus Resection: 28.4%, P = 0.36). Conclusions: Surgery remains the treatment of choice for resectable recurrence. RFA may offer similar benefit in selected patients. [ABSTRACT FROM AUTHOR]

Background: Liver metastases are present in 20.3% of metastatic kidney cancers. The aim of this literature review was to assess the efficacy of surgical treatment for hepatic metastasis from kidney cancer. Methods: An extended web search of the literature was independently performed in March 2018 by two authors according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) statement. Results: Through electronic searches, we identified 935 potentially relevant citations. Thirteen articles were finally included in the systematic review. Median survival after resection ranged from 15 to 142 months while the 1‐, 3‐ and 5‐year overall survival ranged from 69% to 100%, 26% to 83.3% and 0% to 62%, respectively. Median disease‐free survival ranged from 7.2 to 27 months. Conclusion: Surgical treatment of hepatic metastases is performed in approximately 1% of patients with liver metastases and in select patients may be potentially curative. Surgical resection of liver metastases from kidney cancer represents a valid option for selected patients with metastatic renal cancer. Liver metastases are present in 20.3% of metastatic kidney cancers. Surgical resection of liver metastases from kidney cancer represents a valid option for selected patients with metastatic renal cancer. [ABSTRACT FROM AUTHOR]

Background: Hepatic resection is a relatively young and complex specialized procedure. A strong relationship between volume and perioperative mortality has been reported internationally. However, there has been no multicentre study into hepatic resection in Australia. This retrospective, population‐based cohort study was conducted to determine national, state and territory based volume and perioperative mortality rates (POMRs). Methods: Australian Institute of Health and Welfare data was interrogated for the Australian Classification of Health Intervention codes for hepatic resection defined as extended hemi‐hepatectomy (30421), hemi‐hepatectomy (30418), segmental hepatic resection (30415) and sub‐segmental hepatic resection (30414). Logistic regression analysis was performed using the de‐identified data to investigate trends and differences between states/territories. Mortality rates were risk adjusted for age, gender and public or private admission. The data set included patients who underwent hepatic resection in the financial years 2005/2006 to 2012/2013. Results: The overall POMR for all types of hepatic resection was 1.6% (201/12 562). There was no significant change in POMR over time. However, there was significant variation between the states and territories with two states having significantly higher POMR for major hepatic resections (regional range: 1.3–3.8%). POMRs increased with age with the highest mortality seen in the 75–79 year age group. The POMR was lower in private than in public hospitals. Conclusion: The results of this study confirm that the overall Australian POMR for major hepatic resection is similar to results reported internationally. National and state/territory POMR has not varied significantly over time. The significant variation between states/territories warrants further investigation. [ABSTRACT FROM AUTHOR]

Background: Liver metastasis is common in patients with oesophageal cancer. The effect of operative intervention for post‐operative solitary liver metastasis from oesophageal squamous cell carcinoma (ESCC) has not previously been examined. This research was to compare the effect of surgery and non‐surgical therapy in patients with post‐operative solitary liver metastasis from ESCC. Methods: We retrospectively analysed the clinical data of 69 consecutive patients with solitary hepatic metastasis who had undergone oesophagectomy for ESCC and were subsequently referred to the First Affiliated Hospital of Zhengzhou University from January 2005 to December 2013. The survival rates of the surgical and non‐surgical groups were compared. Results: There were 26 patients in the surgical group and 43 patients in the non‐surgical group. There was no operative death in the surgical group. Post‐operative complications were observed in six patients, and all of these patients recovered after additional treatments. Patients in the surgical group had 1‐ and 2‐year cumulative survival rates of 50.8 and 21.2%, respectively, which were significantly higher than the 31.0 and 7.1% survival rates of patients in the non‐surgical group (P < 0.05). In each group, the patients with a disease‐free interval (DFI) lasting >12 months had a better survival rate than those with a DFI lasting ≤12 months (all P < 0.05). Conclusions: Operative intervention is a better treatment choice for patients with post‐operative solitary liver metastasis from ESCC, especially for patients with a DFI lasting >12 months. Patients selected for hepatic resection should be considered on an individual basis through a multidisciplinary team of specialists. [ABSTRACT FROM AUTHOR]

Abstract: Background & Aims: Preoperative prediction of both microinvasive hepatocellular carcinoma and histological grade of hepatocellular carcinoma is pivotal to treatment planning and prognostication. The aim of this study was to evaluate whether some intraoperative ultrasound features correlate with both the presence of same histological patterns and differentiation grade of hepatocellular carcinoma on the histological features of the primary resected tumour. Methods: All patients with single, small hepatocellular carcinoma that underwent hepatic resection were included in this prospective double‐blind study: the intraoperative ultrasound patterns of nodule were registered and compared with similar histological features. Results: A total of 179 patients were enclosed in this study: 97 (54%) patients (34% in HCC ≤2 cm) had a microinvasive hepatocellular carcinoma at ultrasound examination, while 82 (46%) patients (41% in HCC ≤2 cm) at histological evaluation. Statistical analysis showed that diameters ≤2 cm, presence of satellites and microinvasive hepatocellular carcinoma at ultrasound examination were the variables with the strongest association with the histological findings. In the multivariate analysis, the vascular microinfiltration and infiltrative hepatocellular carcinoma aspect were independent predictors for grading. Conclusions: In patients with cirrhosis and hepatocellular carcinoma, the prevalence of microinvasive hepatocellular carcinoma is high, even in cases of HCC ≤2 cm. Intraoperative ultrasound findings strongly correlated with histopathological criteria in detecting microinvasive patterns and are useful to predict neoplastic differentiation. The knowledge of these features prior to treatment are highly desired (this can be obtained by an intraoperative ultrasound examination), as they could help in providing optimal management of patients with hepatocellular carcinoma. [ABSTRACT FROM AUTHOR]

Background: To assess the changes in blood loss during hepatic resection with improved haemostatic devices such as a bipolar sealing device and a topical haemostatic agent. Methods: This retrospective clinical study of prospectively collected data will assess hepatic resections performed by a single surgeon between 2005 and 2013, with the introduction of the two haemostatic techniques in 2009. Results: A total of 371 hepatic resections (214 from 2005 to 2008 and 157 from 2009 to 2013) were included in this study. Compared with the conventional hepatic resection (2005–2008), the use of haemostatic techniques (2009–2013) significantly reduced the need for inflow occlusion (OR: 0.37, 95% CI: 0.24–0.57, P < 0.001), overall occlusion time (20.8 min versus 25.9 min, P = 0.04) and transfusion requirement (4.6% versus 12%, OR: 0.35, 95% CI: 0.14–0.90, P = 0.02). Mean overall blood loss was reduced post‐2009; however, the decrease was not statistically different (401.3 mL versus 470.8 mL, P = 0.27). Subgroup analysis revealed that blood loss was more than halved post‐2009 compared with pre‐2009 for patients who received pre‐operative chemotherapy (324.6 mL versus 738.5 mL, P = 0.005). Conclusion: The use of a bipolar sealing device and a topical haemostatic agent reduces the need for inflow occlusion, overall occlusion time and transfusions in all patients compared with conventional hepatic resections. [ABSTRACT FROM AUTHOR]

Background In recent years, the establishment of new staging systems for hepatocellular carcinoma (HCC) has been reported worldwide. The system combining albumin-bilirubin (ALBI) with tumor-node-metastasis stage, developed by the Liver Cancer Study Group of Japan, was called the ALBI-T score. Methods Patient data were retrospectively collected for 357 consecutive patients who had undergone hepatic resection for HCC with curative intent between January 2004 and December 2015. The overall survival and recurrence-free survival were compared by the Kaplan-Meier method, using different staging systems: the Japan integrated staging (JIS), modified JIS, and ALBI-T. Results Multivariate analysis identified five poor prognostic factors (higher age, poor differentiation, the presence of microvascular invasion, the presence of intrahepatic metastasis, and blood transfusion) that influenced overall survival, and four poor prognostic factors (the presence of intrahepatic metastasis, serum α-fetoprotein level, blood transfusion, and each staging system (JIS, modified JIS, and ALBI-T score)) that influenced recurrence-free survival. Patients for each these three staging system had a significantly worse prognosis regarding recurrence-free survival, but not with overall survival. The modified JIS score showed the lowest Akaike information criteria statistic value, indicating it had the best ability to predict overall survival compared with the other staging systems. Conclusions This retrospective analysis showed that, in post-hepatectomy patients with HCC, the ALBI-T score is predictive of worse recurrence-free survival, even when adjustments are made for other known predictors. However, modified JIS is better than ALBI-T in predicting overall survival. [ABSTRACT FROM AUTHOR]

Aim Hydatidosis is an endemic zoonosis that is prevalent in South America, specifically in Chile, Argentina and Uruguay. Liver hydatidosis (LH) is associated with morbidity and mortality due to evolutionary complications, as well as the risk of complications related to surgical procedures. The surgical treatment of LH can be divided into four phases: isolation of the surgical area, evacuation of the cyst, treatment of the complications of the cyst and treatment of the residual cavity. LH surgical procedures can be classified as conservative and radical. The aim of the present study was to present a general, evidence-based overview of some surgical aspects of interest in the treatment of LH. Patients and Methods An overview was conducted. Articles published between 1990 and 2015 and related to results of surgery in patients with LH were evaluated. PubMed, Web of Science, SciELO and Trip Database were reviewed, and the results of surgery in LH patients were evaluated. Results A total of 301 articles were retrieved, 46 of which met the selection criteria (3 systematic reviews, 2 controlled trials, 5 cohorts studies, 12 observational studies and 24 case series). The studies had a level of evidence of 1b, 2a, 2b, 3a and 4 of prognostic and therapy scenarios. Conclusions The articles found were few and heterogeneous, making meaningful conclusions difficult. Studies with better levels of evidence, methodological quality and population size are needed to make conclusions and recommendations. [ABSTRACT FROM AUTHOR]

Background Serum lactate (sLac) concentration during liver resection with intermittent hepatic hilum clamping (i.e. Pringle maneuver, PM) was retrospectively investigated. Methods A total of 133 patients who underwent liver resection were enrolled. We analyzed the sLac peri-operatively. Correlations were searched between the PM and lactatemia and its variations (i.e. lactate clearance, cLac) and other factors which it might be related to. Lactatemia in triplicate intraoperatively was recorded, just after the awakening, and 1 and 2 h later. The cLac between two consecutive measurements [(sLac1 − sLac2)/sLac1] was computed. Results A reliable dependence of sLac was found from the cumulative PM. More than 76 min of cumulative Pringle Time ( cPT) exposed patients to a worse cLac at the end of the resection phase ( P < 0.0001). We found cPT >76 min, global operation time >365 min and bleeding >225 ml to be predictors of hyperlactatemia ( sLac >4 mmol/L). Normal liver resulted as a risk factor for hyperlactatemia and steatosis was not ( P = 0.030 vs. P = 0.325). Finally, cLac showed a 'square-root- shape, just like the mathematical operation sign. Conclusions Lactatemia during liver resection depends on the duration of PM, bleeding and the duration of the operation. Normal liver may expose the patient to the risk of hyperlactatemia. [ABSTRACT FROM AUTHOR]

Transarterial chemoembolization ( TACE) is recommended for patients with intermediate-stage (Barcelona Clinic Liver Cancer criteria B [ BCLC-B]) hepatocellular carcinoma ( HCC). However, patients with BCLC-B HCC can differ in background factors related to hepatic function, as well as tumor size and number. In the present study, we clarified the role of hepatic resection in patients with BCLC-B HCC. A total of 489 BCLC-B HCC patients with Child-Pugh class A disease initially treated with hepatic resection or TACE were included. After propensity score matching ( n = 264), hepatic resection (hazard ratio [ HR], 0.56; 95% confidence interval [ CI], 0.35-0.91) was independently associated with survival in the multivariate analysis. We then divided patients into two groups based on the results of statistical analysis. There were 170 patients treated with resection and 319 with TACE. Child-Pugh score and number of tumors (cut-off, three tumors) were independently associated with type of HCC treatment in the multivariate analysis. We then divided patients in Group A (Child-Pugh score of 5 and ≤3 tumors; n = 186) and Group B (Child-Pugh score of 6 or ≥4 tumors; n = 303). In Group A, cumulative survival was significantly higher in the hepatic resection group than in the TACE group ( P = 0.014). In Cox proportional hazards models, hepatic resection ( HR, 0.38; 95% CI, 0.23-0.64) was independently associated with survival in Group A patients. In Group B, treatment status was not associated with overall survival. Hepatic resection should be considered in patients with a Child-Pugh score of 5 and ≤3 tumors, despite having BCLC-B HCC. [ABSTRACT FROM AUTHOR]

Aim We aimed to evaluate whether functional assessment of the future remnant liver is a predictor of postoperative morbidity after hepatic resection in patients with hepatocellular carcinoma (HCC). Methods One hundred forty-six patients who underwent hepatic resection for HCC were enrolled in this study. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced MRI (EOB-MRI) analysis for functional liver assessment was carried out before hepatic resection. The signal intensity in the remnant liver was measured and divided by the signal intensity of the major psoas muscle (the liver to major psoas muscle ratio, LMR) for standardization. The remnant liver function was calculated using the formula (LMR on the hepatobiliary phase/LMR on the precontrast image). Computed tomography liver volumetry was also carried out. The remnant functional liver was calculated as the remnant liver volume or volumetric rate × remnant liver function by EOB-MRI. Results Morbidities developed in 19 (13.0%) patients. Morbidities associated with the liver occurred in 7 patients (4.7%). There was no mortality during surgery. Median remnant liver function scores using EOB-MRI and remnant functional liver using volumetric rate or volumetry were 1.82 (range, 1.25-2.96), 155.9 (range, 64.7-285.3), and 1027 (range, 369-2148), respectively. Logistic regression analysis identified the remnant functional liver volume as the only independent predictor for liver-related morbidity. Conclusion Remnant functional liver volume using computed tomography liver volumetry and EOB-MRI was a significantly useful predictor for liver-related morbidity after hepatic resection in patients with HCC. [ABSTRACT FROM AUTHOR]

Background The Barcelona Clinic Liver Cancer ( BCLC) classification is the most widely used staging system for hepatocellular carcinoma ( HCC), but its prognostic ability in patients after resection has not been yet validated. The aim of this study was to evaluate the BCLC classification among patients after resection. Methods The subjects were 196 patients who underwent hepatic resection for HCC between April 2003 and December 2014 at Jikei University Hospital. All patients were classified into a tumor stage according to the BCLC classification. Overall survival rate was calculated according to stages defined by the BCLC classification. Results Overall survival rates at 1, 3 and 5-year were 100%, 95.2% and 95.2% in BCLC 0, 96.7%, 90.0% and 78.4% in BCLC A solitary, 86.2%, 86.2% and 86.2% in BCLC A multiple, 100.0%, 78.8% and 78.8% in BCLC B and 86.5%, 63.3% and 57.6% in BCLC C, respectively. Postoperative complications and mortality rates in relation to BCLC stage were comparable. Conclusion The BCLC treatment algorithm should consider the role of resection also for multiple early, intermediate and advanced stages. [ABSTRACT FROM AUTHOR]

Background & Aims The lack of histopathological confirmation of hepatocellular carcinoma ( HCC) diagnosis for patients receiving ablation may result in misdiagnosis of benign liver nodule as HCC occasionally, contributing to false treatment efficacy. This underestimated issue is one reason why the ablation efficacy remains undetermined compared with hepatic resection. Our aim is to compare the efficacy of ablation and resection for HCC within the Milan criteria after excluding the impact of misdiagnosis. Methods Alpha-fetoprotein > 200 ng/ml was introduced as an inclusion criterion to improve diagnosis accuracy. A total of 435 (resection, 310; ablation, 125) HCC patients within the Milan criteria and without portal hypertension were enrolled. Propensity score matching analysis identified 259 (resection, 150; ablation, 109) patients to compare treatment efficacy. Results Before matching, the survival of resection group were superior to ablation group with 5-year overall survival ( OS) rate of 77.6% vs. 53.8% ( P < 0.001), respectively, and 5-year recurrence-free survival ( RFS) rate of 57.2% vs. 29.1% ( P < 0.001) respectively. After matching, the baseline was well-balanced between the two groups. The 5-year OS rates were 71.5% vs. 51.3% ( P < 0.001), and 5-year RFS rates were 56.1% vs. 25.6% ( P < 0.001) for the resection and ablation groups respectively. Cox regression analysis identified ablation as an independent predictor for mortality and tumour recurrence ( HR: 2.123 and 2.308, respectively; both P < 0.01). Conclusions Hepatic resection provides better OS and RFS than ablation for alpha-fetoprotein positive HCC patients within the Milan criteria and without portal hypertension. [ABSTRACT FROM AUTHOR]

The international normalised ratio is frequently raised in patients who have undergone major liver resection, and is assumed to represent a potential bleeding risk. However, these patients have an increased risk of venous thromboembolic events, despite conventional coagulation tests indicating hypocoagulability. This prospective, observational study of patients undergoing major hepatic resection analysed the serial changes in coagulation in the early postoperative period. Thrombin generation parameters and viscoelastic tests of coagulation (thromboelastometry) remained within normal ranges throughout the study period. Levels of the procoagulant factors II, V, VII and X initially fell, but V and X returned to or exceeded normal range by postoperative day five. Levels of factor VIII and Von Willebrand factor were significantly elevated from postoperative day one (p < 0.01). Levels of the anticoagulants, protein C and antithrombin remained significantly depressed on postoperative day five (p = 0.01). Overall, the imbalance between pro- and anticoagulant factors suggested a prothrombotic environment in the early postoperative period. [ABSTRACT FROM AUTHOR]

Treatment of hepatocellular carcinoma ( HCC) is guided by the tumour stage. The Barcelona clinical liver cancer ( BCLC) score endorsed by the European Society of the Liver EASL divides patients into five prognostic categories, each with a distinct treatment indication. Hepatic resection, orthotopic liver transplantation and percutaneous local ablation are strongly indicated in accurately selected patients with very early ( BCLC 0) and early stage ( BCLC A) tumours providing a survival rate of between 50 and 75% at year five. In patients with a large tumour burden such as those with intermediate stage BCLC B, repeated treatments with transarterial chemoembolization ( TACE) are advocated with clinical benefits (from 16 to 22 months). Survival may also improve in patients who are in poor condition or who do not respond to TACE and those with an advanced HCC ( BCLC C), following oral therapy with the multikinase inhibitor, sorafenib. However, most recommendations are based on uncontrolled studies and expert opinions rather than well-designed controlled trials, and up to one-third of patients do not fit recommendations because of advanced age, the presence of significant comorbidities or a strategic location of the nodule. For these patients, treatment of HCC beyond guidelines is often advocated. [ABSTRACT FROM AUTHOR]

Background: A patient can be considered statistically cured from a specific disease when their mortality rate returns to the same level as that of the general population. In the current study, the authors sought to assess the probability of being statistically cured from intrahepatic cholangiocarcinoma (ICC) by hepatic resection.Methods: A total of 584 patients who underwent surgery with curative intent for ICC between 1990 and 2013 at 1 of 12 participating institutions were identified. A nonmixture cure model was adopted to compare mortality after hepatic resection with the mortality expected for the general population matched by sex and age.Results: The median, 1-year, 3-year, and 5-year disease-free survival was 10 months, 44%, 18%, and 11%, respectively; the corresponding overall survival was 27 months, 75%, 37%, and 22%, respectively. The probability of being cured of ICC was 9.7% (95% confidence interval, 6.1%-13.4%). The mortality of patients undergoing surgery for ICC was higher than that of the general population until year 10, at which time patients alive without tumor recurrence can be considered cured with 99% certainty. Multivariate analysis demonstrated that cure probabilities ranged from 25.8% (time to cure, 9.8 years) in patients with a single, well-differentiated ICC measuring ≤5 cm that was without vascular/periductal invasion and lymph nodes metastases versus <0.1% (time to cure, 12.6 years) among patients with all 6 of these risk factors. A model with which to calculate cure fraction and time to cure was developed.Conclusions: The cure model indicated that statistical cure was possible in patients undergoing hepatic resection for ICC. The overall probability of cure was approximately 10% and varied based on several tumor-specific factors. Cancer 2015;121:3998-4006. © 2015 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background & Aims Advanced liver fibrosis is associated with recurrence after curative resection of hepatocellular carcinoma ( HCC). This study aimed to investigate whether noninvasive fibrosis indices could predict intrahepatic recurrence and death after curative resection of HCC. Methods Patients who underwent curative resection for hepatitis B virus ( HBV)-related HCC between 2006 and 2010 at a single tertiary hospital were included. This study analysed the association of noninvasive fibrosis indices with recurrence and overall survival. Results A total of 303 patients were included. During a median follow-up period of 56.0 (interquartile range, 42.0-70.0) months, 151 (49.8%) patients experienced HCC recurrence and 54 (17.8%) died. Based on multivariate analysis, Forns index [hazard ratio ( HR), 1.238; 95% confidence interval ( CI), 1.097-1.398; P = 0.001] was independently associated with tumour recurrence after adjustment for anti- HBe positivity, histological cirrhosis, tumour size and number. Patients with Forns index <6.9 had a significantly longer recurrence-free survival rate than patients with Forns index ≥6.9 ( P < 0.001 by log-rank test). Forns index ( HR, 1.246; 95% CI, 1.034-1.501; P = 0.02) could also predict overall survival after adjustment for tumour size and number. Forns index detected cirrhosis with an AUROC of 0.700 (95% CI, 0.641-0.758). Aspartate aminotransferase-to-platelet ratio index, cirrhosis discriminant score, FIB-4 index, P2/ MS and Lok index detected cirrhosis comparably to Forns index, but were not associated with tumour recurrence or death. Conclusions Our data suggest that Forns index could be a useful predictor of recurrence and overall survival after curative resection of HBV-related HCC. [ABSTRACT FROM AUTHOR]

Background: Patients with colorectal liver metastasis (CRLM) might be down‐staged by chemotherapy from an initially unresectable stage to a resectable stage. Because the tumor response to preoperative chemotherapy has been correlated with resection rate, the improved efficacy from the concept that only the patients without K‐ras mutations receive an anti‐EGFR antibody might be expected to increase the conversion rate. The purpose of this study is to evaluate the conversion rate from unresectable CRLM to complete resection. Methods: We conducted a multi‐institutional phase II trial for unresectable CRLM. Patients received mFOLFOX6 with either bevacizumab (bev) or cetuximab (cet) based on K‐ras status (UMIN000004310). Planned treatment was for six cycles during which tumors were assessed for resectability every three cycles. Patients whose disease was unresectable after six cycles switched their chemotherapy regimen from mFOLFOX6 to FOLFIRI. The primary endpoint was R0 resection rate. Results: Thirty‐five patients with unresectable CRLM were enrolled. A total of 22/12 patients with K‐ras wild‐type/mutant (wt/mt) were treated with mFOLFOX6 plus cet/bev, respectively. The overall response rate was 64.7% (wt/mt; 77.3%/41.7%, P = 0.04). In 20 patients (58.8%), hepatectomy was performed according to protocol treatment, and the conversion rate was 72.7%/33.3% in wt/mt patients, respectively (P = 0.03). Finally, 23 patients (67.6%) underwent hepatectomy, and the conversion rate was 77.2%/50.0% in wt/mt patients (P = 0.09). The overall R0 resection rate was 47.1% (wt/mt; 50.0%/41.7%, P = 0.36). Conclusions: This prospective study showed that combined chemotherapy based on K‐ras status can facilitate conversion to resection in patients with unresectable CRLM. [ABSTRACT FROM AUTHOR]

The management of hepatocellular carcinoma (HCC) is decided according to evidence-based recommendations generated by international societies: according to these recommendations, the tumour stage, as determined by the Barcelona clinical liver cancer (BCLC) score, divides patients into five prognostic categories, each with a distinct treatment indication. Radical therapies such as hepatic resection, orthotopic liver transplantation and percutaneous local ablation are strongly indicated in patients with very early and early stage tumours (BCLC O and A), a choice which mainly depends on a combination of tumour volume, status of underlying liver disease, the presence of comorbidities and the patient's age. Although radical therapies provide a survival rate of between 50% and 75% at year five in well selected patients, tumour recurrence is frequent following resection and ablation compared to transplantation (70% vs. 10% respectively), which has the additional advantage of preventing morbidity and mortality from portal hypertension. Generally, while radical therapies are contraindicated in patients with a large tumour burden, such as those with intermediate stage BCLC B, survival in the subset of these patients with well compensated cirrhosis may improve from 16 to 20 months, on average, following repeated treatments with transarterial chemoembolization (TACE). Survival may also improve in patients who are in poor condition or who do not respond to TACE and in those with an advanced HCC (BCLC C) following oral therapy with the multikinase inhibitor sorafenib. However, because most recommendations are based on uncontrolled studies and expert opinions rather than well designed, high powered randomized controlled trials, treatment criteria need to be adapted to special groups because real life cohorts do not match the selection criteria suggested by the guidelines. Indeed, up to one-third of patients with early stage tumours who are unfit for radical therapy because of advanced age, the presence of significant comorbidities or a strategic location of the nodule, are forced to receive palliative care. BCLC A patients with moderate portal hypertension and certain BCLC B patients could still be eligible for hepatic resection if a chance for 50% survival at 5 years is still perceived as being cost-effective by both the patient and caregivers. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to validate the Beppu nomogram, which predicts disease‐free survival (DFS) after resection of colorectal liver metastases, and to investigate the efficacy of neoadjuvant chemotherapy based on the nomogram‐predicted recurrence risk. Methods: We retrospectively analyzed 234 patients with colorectal liver metastases who underwent a hepatic resection at eight hospitals between 2005 and 2010. Results: The nomogram c‐index of all the patients was 0.59. The observed and the predicted 3‐year DFS showed good agreement. When the patients were divided into two groups who received or did not receive pre‐hepatectomy chemotherapy (PHC), the c‐index of the patients who received PHC was inferior to that of the patients who did not (0.56 and 0.61, respectively). In patients who received PHC, DFS among the quintiles clustered by the nomogram score indicated no significant differences (P = 0.25), unlike in patients who did not receive PHC (P < 0.0001). Surprisingly, in patients with no risk factors for recurrence, neoadjuvant chemotherapy provided significantly lower DFS than no neoadjuvant chemotherapy (3‐year DFS: 42.9% vs. 80.0%, P = 0.03). Conclusions: The nomogram validation was shown to be moderately predictive. PHC decreased the performance of the nomogram and might produce no DFS benefit in patients with low recurrent risk. [ABSTRACT FROM AUTHOR]

Aim Histologically, poorly differentiated hepatocellular carcinomas ( HCC) are considered highly malignant. Here, we aimed to evaluate the relative efficacy and safety of hepatic resection or radiofrequency ablation ( RFA) for treating this malignancy. Methods Between April 2004 and May 2011, we enrolled 48 patients who had poorly differentiated HCC that had been diagnosed postoperatively by pathological assessment. All the tumors had a maximum diameter of 3 cm and all patients had three or less tumors. Fifteen of these patients underwent hepatic resection ( HR group) and 33 patients underwent RFA ( RF group). The patient background, tumor characteristics, overall survival rate and recurrence-free survival rate were assessed in both groups. Results The mean maximum tumor diameter was 2.5 and 2.0 cm in the HR and RF groups, respectively. The prothrombin activity level was 94% and 86% in the HR and RF groups, respectively. The 1-, 3- and 5-year cumulative survival rates were 89.1%, 68.7% and 68.7%, respectively, in the HR group, and 59.2%, 40.9% and 32.7%, respectively, in the RF group. The 1-, 3- and 5-year recurrence-free survival rates were 85.1%, 64.8% and 48.6%, respectively, in the HR group, and 29.0%, 7.2% and 7.2%, respectively, in the RF group. There was a significant difference between these groups ( P < 0.05). Conclusion As hepatic resection has greater efficacy than RFA in the treatment of poorly differentiated HCC, even in cases with a small tumor size, we recommend its use for this malignancy. [ABSTRACT FROM AUTHOR]

Cholangiocarcinoma is the most common cancer in the northeast of Thailand. Most of the patients present when the disease is in an advanced stage. Improvement of preoperative diagnoses and surgical techniques provide more satisfactory results. Herein we reviewed our 30‐year experience in management of perihilar cholangiocarcinoma in Khon Kaen northeast Thailand. Between 1982 and 2012 we reviewed four specific studies of perihilar cholangiocarcinoma in Srinagarind Hospital, Khon Kaen, Thailand. The first study focused on advanced surgical pathology and palliative surgery, which were used to treat obstructive jaundice cholangiocarcinoma patients. Long‐term survival in this study was rare with a one‐year survival of just 15%. The second study was conducted on 30 consecutive cases of perihilar cholangiocarcinoma who presented with obstructive jaundice without preoperative biliary drainage. All the patients underwent major liver resection with bilio‐enteric reconstruction. Perioperative mortality was 6.7% without a 5‐year survival. The third study aimed to analyze the survival rates and factors affecting survival in extrahepatic CCA patients following surgical treatment at Srinagarind Hospital and concluded that resection margins are an important prognostic factor. The last study objective was the analysis of curative surgical attempt in 99 consecutive perihilar cholangiocarcinoma and results showed that R0 resection could improve long‐term survival. We evaluated four studies of perihilar cholangiocarcinoma in Srinagarind Hospital, Khon Kaen, Thailand from 1982–2012. Viewed chronologically there has been a progressive improvement of diagnosis and surgical treatment during the past 30 years. Despite these advances the 5‐year survival rate remains unsatisfactorily low. Future improvement of patient selection and surgical techniques can lead to a greater survival rate for patients. [ABSTRACT FROM AUTHOR]

Aim: To compare the recurrence and survivals between hepatocellular carcinoma (HCC) with major portal vein tumor thrombus (TT) and major hepatic vein TT after hepatic resection (HR). Methods: A retrospective study was carried out with the medical records of 272 patients who underwent hepatic resection and thrombectomy for HCC with major portal vein (group A) or hepatic vein (group B) TT. The clinicopathological parameters, recurrence, survivals and prognostic significance associated with major portal or hepatic vein TT were analyzed. Results: Patients in group A had a better median survival compared with their counterparts in group B (52 vs 38 weeks; P < 0.001). One-, 2- and 3-year survival rates were markedly greater in group A than in group B (50% vs 38.8%, 26% vs 15.9% and 11.4% vs 6.1%, respectively). There was no statistical difference in recurrence-free survival rate but extrahepatic recurrences were more often seen in group B. In multivariate analysis, TT location (hepatic veins vs portal veins), type of resection (anatomical vs non-anatomical) and liver cirrhosis (none/mild vs moderate/severe) were significant prognostic factors. Conclusion: Patients with HCC and major hepatic vein TT had higher incidence of extrahepatic metastases and worse overall survival after hepatic resection compared with patients with major portal vein TT. With preserved liver function, patients can receive aggressive treatments and survivals could be prolonged. [ABSTRACT FROM AUTHOR]

Objectives The systematic reviews (SRs) of radiofrequency ablation (RFA) versus hepatic resection (HR) for early hepatocellular carcinoma (HCC) are increasing with varies qualities. The aim of this study is to evaluate quality and their impacts on outcomes of these studies. Methods We searched six databases and five official websites to find the SRs of RFA versus HR for early HCC. The Overview Quality Assessment Questionnaire (OQAQ), the Cochrane Collaboration's tool, and modified MINORS score were applied to assess their quality for SRs, randomized (RCTs) and nonrandomized controlled trials (NRCTs), respectively. Results Nineteen SRs were included. The results showed that the overall quality was poor, with a mean OQAQ score of 3.3 and 95%CI 2.6 to 4.1, only five (26.3%) SRs were good quality, six (31.6%) misused the statistical models, and three of them changed outcome direction after modification. Five SRs taken retrospective studies as RCT. In addition, a total of 39 primary studies referenced by these 19 SRs were included. The results showed that 3 RCTs were leveled grade B, and 35 NRCTs were of moderate quality, with an estimated mean MINORS score of 15.0 and 95%CI 14.6 to 15.4. Conclusions The overall quality of SRs comparing the effects between RFA and HR for early HCC was poor. There was high heterogeneity and low evidence level. Physicians should take caution when applying the results from these studies to their clinical practice. [ABSTRACT FROM AUTHOR]

Background and Aim This study aimed to investigate the prognostic value of expression of hepatocyte nuclear factors ( HNFs) involved in hepatic gene transcription in patients undergoing curative resection for hepatocellular carcinoma ( HCC). Methods We performed immunohistochemical analyses on microarrays of the tumors and matched adjacent tissue using antibodies against HNF1α, HNF1β, HNF4α, and α-fetoprotein ( AFP). We evaluated the prognostic value of biomarker expression using Cox regression and the Kaplan- Meier method in a training cohort of 220 patients and conducted an independent validation in 232 patients. We also determined whether measurement of HNFs improved risk prediction beyond the use of established factors, using net reclassification improvement ( NRI). Results Post-surgical recurrence and hepatic death were predicted by intratumoral HNF4α underexpression in both cohorts. In the training cohort they were also predicted by peritumoral HNF1α positivity. A pooled cohort analysis showed that these predictors were independently associated with early but not late-phase recurrence, and resultant mortality. Intratumoral expression levels of HNF4α were correlated with those of HNF1α, HNF1β, and AFP ( P < 0.05). Similarly, HNF1α expression in peritumoral tissue was correlated with that of other markers ( P < 0.05). There was no significant correlation between expression of HNF4α in tumors and HNF1α in peritumoral tissue. Adding combinations of intratumoral HNF4α and peritumoral HNF1α to 2-year recurrence and 5-year mortality models including known clinicopathological prognostic factors significantly improved the NRI indexes (39% and 44%, respectively; P < 0.05). Conclusions Immunohistological activation of intratumoral HNF4α and depletion of peritumoral HNF1α have prognostic significance for delayed recurrence and death after HCC resection. [ABSTRACT FROM AUTHOR]

Background The optimal cut-off value of the number of colorectal liver metastases ( CRLM) to predict prognosis after hepatic resection remains unclear. This study was conducted to determine a suitable cut-off value. Methods A total of 727 hepatectomized patients with CRLM were evaluated. We proposed the following optimal cut-off values: first, a small P-value for the log-rank test with no overlapping of the 95% confidence interval ( CI) for median survival time using the Kaplan- Meier method and the hazard ratio ( HR) using the Cox proportional hazards model and, second, the maximum HR value for accurate separation. Results For disease-free survival analysis, of the three group separations, A2 (1, 2-4, and ≥5) showed a small P-value and the largest HR, whereas two group separations, B2, B3 and B4 showed similarly small P-values, but B4 (1-4, ≥5) indicated the largest HR. Regarding the overall survival analysis, of the three group separations, A2 showed the smallest P-value, whereas the two group separations, B4 showed similarly small P-values, with the largest HR. Conclusions Tumor number separation in patients with CRLM after hepatic resection should be performed using the A2 (1, 2-4, and ≥5) or B4 (1-4 and ≥5) classifications. [ABSTRACT FROM AUTHOR]

Patients with colorectal liver metastasis ( CRLM) can be cured with surgical resection. Recent advances in systemic chemotherapy, including molecular target agents, can be used to introduce 'conversion surgery' and achieve R0 resection even in patients with initially unresectable CRLM. Furthermore, neoadjuvant chemotherapy also tries to be applied in patients with resectable CRLM to maximize the remnant liver and reduce the residual micrometastasis before surgery. The development of chemotherapy-induced hepatic injuries is increasingly being recognized, including sinusoidal obstructive syndrome ( SOS), steatosis, steatohepatitis and biliary sclerosis. Especially, oxaliplatin ( L-OHP)-based chemotherapy in clinical settings appears to be primarily associated with SOS. Various reports have tried to demonstrate the rationale of the correlation between L-OHP-based chemotherapy and SOS for the following hepatic surgery. While we can recognize that this pathophysiological disadvantage leads to hepatic dysfunction and the increasing postoperative morbidity, the essential part of this problem including clinical disadvantage, onset mechanism, evaluation systems, and targeted agents for prevention and treatment of SOS continue to be unclear. In this review, we summarize the current experience with hepatic injury induced by L-OHP-based chemotherapy, focusing on SOS-based on clinical and experimental data, in order to assist in the resolution of these identified factors. Finally, the need for reliable methods to identify the risk of SOS, to evaluate SOS status and to predict the safety of surgical treatment in patients with chemotherapy prior to surgery will be emphasized. [ABSTRACT FROM AUTHOR]

Background and Aim Upfront liver transplantation is the gold standard in the treatment of patients with hepatocellular carcinoma ( HCC) and cirrhosis, but a shortage of donor organs negatively impacts on survival outcomes, with significant disease progression during long waiting lists. This systematic review evaluates the safety and efficacy of salvage liver transplantation ( SLT) as treatment for recurrent HCC after initial hepatic resection. Methods Electronic searches of Pubmed, Embase, and Medline databases identified 130 abstracts, from which 16 eligible studies comprising 319 patients were selected for review. Studies adopting SLT following primary hepatic resection for recurrent HCC with more than five patients were included. Demographic details, morbidity and mortality indices, and survival outcomes were collected from each study and were tabulated. Results All patients included in the studies had liver cirrhosis, with the majority being Child- Pugh A (50%) and B (33%). The etiology of liver disease was hepatitis B in the majority of patients (84%). Disease recurrence occurred in 27-80% of patients at a median of 21.4 months (range 14.5-34) following initial resection. SLTs were performed on 41% of recurrences, and were associated with biliary complications (8%), infection (11%), bleeding (8%), and vascular complications (7%). There were 18 perioperative deaths (5.6%). The median 1-, 3-, and 5-year overall and disease-free survival was 89%, 80%, and 62%, and 86%, 68%, and 67%, respectively. Conclusion Synthesis of available observational studies suggests that SLT following primary hepatic resection is a highly applicable strategy with long-term survival outcomes that are comparable to upfront liver transplantation. [ABSTRACT FROM AUTHOR]

Background There is increasing evidence showing that hepatic resection is probably the best definitive treatment for unilateral hepatolithiasis. However, the role of hepatic resection for bilateral hepatolithiasis is rarely mentioned in the literature. Methods We retrospectively reviewed 197 patients who underwent hepatic resection for hepatolithiasis in Changhua Christian Hospital from December 1987 to December 2007. A total of 156 patients with unilateral hepatolithiasis were defined as the UNI group (control group), and 41 patients with bilateral hepatolithiasis were defined as the BI group (study group). The short- and long-term outcomes were measured. Results The BI group had longer operating time (200 min versus 173 min, P = 0.006), lower immediate stone clearance rate (56.1% versus 91.7%, P < 0.001), lower final stone clearance rate (75.6% versus 94.9%, P = 0.001), higher rate of stone recurrence (22.6% versus 6.1%, P = 0.009) and higher disease-related mortality (19.5% versus 5.1%, P = 0.006). Thirty patients with bilateral peripheral stones were indicated for bilateral hepatectomy, but only 20 (66.7%) of them actually underwent the proposed procedure. Of the patients who did not achieve immediate stone clearance, bilateral peripheral stones represented 88.9% ( P = 0.044). Of the patients who had stone recurrence, patients less than 35 years old represented 42.9% ( P = 0.007). Conclusion Bilateral hepatolithiasis has worse outcomes than unilateral hepatolithiasis after being treated with hepatic resection. Regarding bilateral peripheral stones, there is often a discrepancy between the extent of stone-affected parenchyma and that of final liver resection, resulting in a lower immediate stone clearance rate. A higher stone recurrence rate was observed among younger population. [ABSTRACT FROM AUTHOR]

Histological reporting of hepatic resections of colorectal liver metastases ( CRLMs) is limited to confirmation of diagnosis and evaluation of resection margins. More exhaustive diagnostic reporting might be warranted. Here, we critically and systematically review the potentially important histological prognostic factors in CRLM. Histological features such as intrahepatic spread, resection margins, and tumour response to neoadjuvant chemotherapy have been defined. Intrahepatic spread (venous, lymphatic, bile duct and perineural invasion) was evaluated in a number of studies. Meta-analysis demonstrated a clear correlation between 5-year overall survival and both portal vein invasion ( RR 1.8, 95% CI 1.3-2.5) and lymphatic invasion ( RR 1.7, 95% CI 1.4-2.0). The impact of hepatic vein invasion and bile duct invasion on outcome is not clear. Perineural invasion was linked to survival in one study. Resection margin is an important prognostic factor; however, the significance of the width of negative margins remains controversial. Various studies have evaluated tumour response to neoadjuvant chemotherapy, but different grading systems were used, and definite recommendations cannot be made. In conclusion, with the high incidence of CRLM and the increase in the number of hepatic resections, we need well-defined prognostic factors, studied in homogeneous patient populations, to optimize diagnostic work-up. This review identifies several of these factors. [ABSTRACT FROM AUTHOR]

Aim It is a matter of debate whether hepatic resection ( HR) or radiofrequency ablation ( RFA) should be preferred for the treatment of patients with hepatocellular carcinoma ( HCC). The aim of this study is to compare the long-term outcome between HR and RFA in patients with solitary small-sized HCC. Methods One hundred and eighty-three patients with solitary HCC of 3 cm or less who underwent either HR ( n = 101) or RFA ( n = 82) as a first-line treatment were enrolled in this study. Their cumulative disease-free and overall survival and prognostic factors were compared. Results The disease-free and overall survival in the HR group were significantly better than those in the RFA group for HCC of 3 cm or less; the 5-year disease-free and overall survival rates were 46.8% versus 23.9% and 87.5% versus 59.4% ( P = 0.0008, =0.0002), respectively. In the subgroup analysis, the disease-free and overall survival in the HR group were significantly better than those in the RFA group for HCC of more than 2 cm ( P < 0.0001, <0.0001, respectively), whereas there were no significant differences between the two groups for HCC of 2 cm or less. In patients treated with RFA, a tumor size of more than 2 cm was the only independent prognostic factor for disease-free survival (risk ratio = 1.832, P = 0.039). Conclusion HR is proposed as the first-line treatment for patients with solitary small-sized HCC rather than RFA, especially for those with tumors in the range 2-3 cm. [ABSTRACT FROM AUTHOR]

Background: For patients with bulky liver tumors that have invaded all three hepatic veins at the hepatic venous confluence to the inferior vena cava (IVC), reconstruction of at least one hepatic vein outlet to the IVC is necessary. Methods: To effectively treat these tumors, we performed 7 ante-situm liver resections. The ante-situm position provides surgeons with excellent visualization of the anatomical structures that should be maintained in the remnant liver. In addition, replacement of the involved IVC by a ringed expanded polytetrafluoroethylene (ePTFE) graft can be safely completed. Results: Because of the far-advanced malignancies of our 7 patients, the survival periods after surgery were limited, but the survival benefits of the procedure were not disappointing. From what has been reported in the literature, the survival periods in our patients appear to justify the employment of the procedure even when compared with survivals in patients who have less complex tumor extensions. Conclusion: Because of the complexity of this procedure, a team of surgeons familiar with liver surgery and liver transplantation in a specialized hepatobiliary center is required. However, we anticipate that this procedure will be feasible and justified for selected patients in whom tumor invasion at the confluence of all three hepatic veins and the IVC is too extensive to treat with other surgical procedures. [ABSTRACT FROM AUTHOR]

Background/purpose: The indications for hepatic resection for hepatocellular carcinoma (HCC) patients with total bilirubin (T-Bil) equal to or higher than 1.2 mg/dl remain controversial. The aim of this study was to investigate the safety of hepatic resection for HCC patients who showed high T-Bil (≥1.2 mg/dl) with low direct bilirubin (D-Bil ≤ 0.5 mg/dl). Methods: Thirty-four HCC patients showing high T-Bil with low D-Bil were treated with mono- to tri-segmentectomy between January 2000 and December 2010. The perioperative clinical parameters and prognosis of the high T-Bil/low D-Bil patients were compared with those of 253 HCC patients showing normal T-Bil. In addition, complication rates of the patients with high T-Bil/high D-Bil ( n = 4) were analyzed. Results: The prothrombin time activity, indocyanine green clearance test, asialo-scintigraphy, and platelet count were similar in the two groups. The mean serum albumin in high T-Bil/low D-Bil patients was significantly higher than that of normal T-Bil patients (4.2 ± 0.5 vs. 4.0 ± 0.4 g/dl, P = 0.004). There were no significant differences in operation time, intraoperative bleeding, red cell concentrate transfusion rate, postoperative complication rate, and disease-free and overall survivals between the two groups. Postoperative hyperbilirubinemia (T-Bil >5 mg/dl) with ascites was observed in one of four high T-Bil/high D-Bil patients (25 %). Conclusions: Mono- to tri-segmentectomy can be performed in patients with low D-Bil (≤0.5 mg/dl) similarly to patients with low T-Bil (<1.2 mg/dl), even in HCC patients showing high T-Bil (≥1.2 mg/dl). [ABSTRACT FROM AUTHOR]

Background: The role of adjuvant chemotherapy for stage IV colorectal cancer has so far been under-investigated. The aim of this study was to assess the feasibility and short-term outcome of adjuvant chemotherapy with the FOLFOX regimen following liver resection for patients with colorectal liver metastasis (CRLM). Methods: From May 2005 to September 2010, 86 patients with CRLM underwent hepatic resection in the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University. Of these patients, 24 received FOLFOX4 or modified FOLFOX6 as postoperative adjuvant chemotherapy. Results: Nineteen male and 5 female patients received adjuvant chemotherapy following liver resection. Twenty-one (87.5 %) of these patients completed 6 cycles of adjuvant chemotherapy. Five patients required a dose reduction due to neutropenia, and the dose intensities of oxaliplatin and 5-FU were 93.6 and 94.1 %, respectively. There were no severe adverse events from the treatments. The median follow-up period was 48.4 months. Recurrences developed in 12 patients, and 3 patients died during the follow-up period. The 3- and 5-year disease-free survival and overall survival were 51.6 and 45.1 % and 95.5 and 76.0 %, respectively. Conclusions: Adjuvant FOLFOX is feasible and might provide a good prognosis for CRLM patients who undergo liver resection. [ABSTRACT FROM AUTHOR]