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INTRODUCTION: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the third leading cause of cancer-related deaths worldwide. Hepatic resection is the treatment of choice for non-cirrhotic patients, while in cirrhotic individuals, the choice depends on tumor stage and liver function. METHODS: In this retrospective study conducted at Hospital El Cruce between 2015 and 2022, patients with HCC undergoing hepatic resection, both cirrhotic and non-cirrhotic, were evaluated. Morbidity, mortality, recurrence rate, and survival were analyzed. RESULTS: A total of 262 hepatectomies were performed, with 44 for HCC treatment. Among them, 35 were minor hepatectomies, and 9 were major hepatectomies (noncirrhotic patients). The majority were males (77%) with an average age of 58.5 years. Twenty-nine patients had cirrhosis, with hepatitis C (HCV) being the main cause in 48%, HCV with alcohol as a cofactor (21%), and alcohol alone (17%). Morbidity was 47.7%, with predominance of minor complications. Disease recurrence occurred in 59% of patients, and associated factors included tumor size and elevated AFP levels. Survival was better in cirrhotic patients compared to non-cirrhotic ones. DISCUSSION: Results tion 5837 Hepatic resection is an effective option for treating HCC in well-selected cirrhotic and non-cirrhotic patients, with encouraging results in terms of survival and disease control. Additionally, close surveillance for early recurrence detection and timely interventions is suggested.
Introducción: El carcinoma hepatocelular (HCC) es el cáncer primario más común del hígado y la tercera causa principal de muerte por cáncer en todo el mundo. La resección hepática es el tratamiento de elección para pacientes no cirróticos, mientras que, en cirróticos, la elección depende del estadio tumoral y la función hepática. Métodos: En este estudio retrospectivo realizado en el Hospital El Cruce entre 2015 y 2022, se evaluaron pacientes con HCC sometidos a resección hepática, tanto cirróticos como no cirróticos. Se analizó la morbimortalidad, la tasa de recurrencia y la sobrevida. Resultados: Se realizaron 262 hepatectomías, 44 fueron para tratamiento del HCC, de las cuales 35 fueron hepatectomías menores, y 9 hepatectomías mayores (no cirróticos). La mayoría eran hombres (77%) con una edad promedio de 58.5 años. Hubo 29 pacientes con cirrosis, siendo la hepatitis C (HCV) la causa principal en un 48%, HCV con alcohol como cofactor (21%) y alcohol (17%). La morbilidad fue del 47.7%, con complicaciones menores predominantes. La recurrencia de enfermedad ocurrió en el 59% de los pacientes, y los factores asociados incluyeron tamaño tumoral y niveles elevados de Alfafetoproteína. La supervivencia fue mejor en pacientes cirróticos en comparación con no cirróticos. Conclusión: La resección hepática es una opción efectiva para el tratamiento del HCC en pacientes bien seleccionados cirróticos y no cirróticos, con resultados alentadores en términos de supervivencia y control de la enfermedad. Además, se sugiere una vigilancia cercana para detectar recurrencias tempranas y proporcionar tratamientos oportunos.
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Carcinoma Hepatocelular , Hepatectomía , Cirrosis Hepática , Neoplasias Hepáticas , Recurrencia Local de Neoplasia , Humanos , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/mortalidad , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/mortalidad , Masculino , Hepatectomía/métodos , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Cirrosis Hepática/cirugía , Cirrosis Hepática/complicaciones , Adulto , Resultado del TratamientoRESUMEN
INTRODUCTION AND OBJECTIVES: The absence of melanoma 2 (AIM2) protein triggers the activation of the inflammasome cascade. It is unclear whether AIM2 plays a role in hepatocellular carcinoma (HCC) and radiofrequency ablation (RFA), which uses radiofrequency waves to treat tumors. In this study, we investigated if RFA could induce pyroptosis, also called cell inflammatory necrosis, in HCC through AIM2-inflammasome signaling in vivo and in vitro. MATERIALS AND METHODS: BALB/c nude mice were used to generate HepG2 or SMMC-7721 cell-derived tumor xenografts. HCC cells with knockdown or overexpression of AIM2 were created using short hairpin RNA (shRNA) and expression vector transfection, respectively, for functional and mechanistic studies. Downstream effects were examined using flow cytometry, qRT-PCR, ELISAs, and other molecular assays. RESULTS: RFA significantly suppressed tumor growth in HCC cell xenografts. Flow cytometry analysis revealed that RFA could induce pyroptosis. Furthermore, AIM2, NLRP3, caspase-1, γ-H2AX, and DNA-PKc had significantly greater expression levels in liver tissues from mice treated with RFA compared with those of the controls. Additionally, interleukin (IL)-1ß and IL-18 expression levels were significantly higher in the HCC cell-derived xenograft mice treated with RFA compared with those without RFA. Notably, a significantly greater effect was achieved in the RFA complete ablation group versus the partial ablation group. Knockdown or overexpression of AIM2 in HCC cells demonstrated that AIM2 exerted a role in RFA-induced pyroptosis. CONCLUSIONS: RFA can suppress HCC tumor growth by inducing pyroptosis via AIM2. Therefore, therapeutically intervening with AIM2-mediated inflammasome signaling may help improve RFA treatment outcomes for HCC patients.
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Carcinoma Hepatocelular , Proteínas de Unión al ADN , Inflamasomas , Interleucina-1beta , Neoplasias Hepáticas , Piroptosis , Ablación por Radiofrecuencia , Animales , Humanos , Ratones , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/cirugía , Caspasa 1/metabolismo , Caspasa 1/genética , Proteínas de Unión al ADN/metabolismo , Proteínas de Unión al ADN/genética , Células Hep G2 , Histonas/metabolismo , Inflamasomas/metabolismo , Interleucina-18/metabolismo , Interleucina-18/genética , Interleucina-1beta/metabolismo , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/cirugía , Ratones Endogámicos BALB C , Ratones Desnudos , Proteína con Dominio Pirina 3 de la Familia NLR/metabolismo , Proteína con Dominio Pirina 3 de la Familia NLR/genética , Transducción de Señal , Carga TumoralRESUMEN
Ischemia-reperfusion injury (IRI) during liver transplantation has been implicated in the recurrence of hepatocellular carcinoma (HCC). This systematic review aimed to evaluate interventions to reduce IRI during liver transplantation for HCC and their impact on oncologic outcomes. A comprehensive literature search retrieved four retrospective studies involving 938 HCC patients, utilising interventions such as post-operative prostaglandin administration, hypothermic machine perfusion, and normothermic machine perfusion. Overall, treated patients exhibited reduced post-operative hepatocellular injury and inflammation and significantly enhanced recurrence-free survival. Despite these promising results, the impact of these interventions on overall survival remains unclear. This underscores the imperative for further prospective research to comprehensively understand the efficacy of these interventions in HCC patients undergoing transplantation. The findings highlight the potential benefits of these strategies while emphasising the need for continued investigation into their overall impact.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Trasplante de Hígado , Daño por Reperfusión , Humanos , Daño por Reperfusión/prevención & control , Daño por Reperfusión/etiología , Trasplante de Hígado/métodos , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , Resultado del Tratamiento , AloinjertosRESUMEN
The study investigates the efficacy of a bioinspired Particle Swarm Optimization (PSO) approach for PID controller tuning in Radiofrequency Ablation (RFA) for liver tumors. Ex-vivo experiments were conducted, yielding a 9th order continuous-time transfer function. PSO was applied to optimize PID parameters, achieving outstanding simulation results: 0.605% overshoot, 0.314 seconds rise time, and 2.87 seconds settling time for a unit step input. Statistical analysis of 19 simulations revealed PID gains: Kp (mean: 5.86, variance: 4.22, standard deviation: 2.05), Ki (mean: 9.89, variance: 0.048, standard deviation: 0.22), Kd (mean: 0.57, variance: 0.021, standard deviation: 0.14) and ANOVA analysis for the 19 experiments yielded a p-value ⪠0.05. The bioinspired PSO-based PID controller demonstrated remarkable potential in mitigating roll-off effects during RFA, reducing the risk of incomplete tumor ablation. These findings have significant implications for improving clinical outcomes in hepatocellular carcinoma management, including reduced recurrence rates and minimized collateral damage. The PSO-based PID tuning strategy offers a practical solution to enhance RFA effectiveness, contributing to the advancement of radiofrequency ablation techniques.
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Neoplasias Hepáticas , Ablación por Radiofrecuencia , Neoplasias Hepáticas/cirugía , Ablación por Radiofrecuencia/métodos , Humanos , Carcinoma Hepatocelular/cirugía , Animales , Algoritmos , Simulación por Computador , Ablación por Catéter/métodosRESUMEN
INTRODUCTION AND AIMS: Hepatocellular carcinoma (HCC) is a primary malignant tumor of liver epithelial cells and is the most frequent primary liver cancer. The broadening of transplantation and resectability criteria has made therapeutic decisions more complex. Our aim was to describe the clinical and survival characteristics of patients with HCC treated through resection or liver transplantation at our hospital and identify the presence of factors that enable outcome prediction and facilitate therapeutic decision-making. MATERIALS AND METHODS: Patients with HCC that underwent surgery with curative intent at the Hospital Universitario Marqués de Valdecilla, within the time frame of 2007 and 2017, were retrospectively identified. Survival, mortality, disease-free interval, and different outcome-related variables were analyzed. RESULTS: Ninety-six patients with a mean follow-up after surgery of 44 months were included. Overall mortality and recurrence were higher in the resection group. Mean survival was 51.4 months in the liver transplantation group and 37.5 months in the resection group, and the disease-free interval was 49.4⯱â¯37.2 and 27.4⯱â¯28.7 months, respectively (pâ¯=â¯0.002). The tumor burden score was statistically significant regarding risk for recurrence and specific mortality. CONCLUSIONS: There appears to be no patient subgroup in whom the results of surgical resection were superior or comparable to those of transplantation. Tumor burden determination could be a useful tool for patient subclassification and help guide therapeutic decision-making.
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Carcinoma Hepatocelular , Hepatectomía , Neoplasias Hepáticas , Trasplante de Hígado , Centros de Atención Terciaria , Humanos , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/mortalidad , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Trasplante de Hígado/mortalidad , Anciano , Análisis de Supervivencia , Adulto , Recurrencia Local de Neoplasia/cirugía , Resultado del Tratamiento , Estudios de Seguimiento , Carga Tumoral , Supervivencia sin EnfermedadRESUMEN
In this editorial, we comment on the article by Zhang et al entitled Development of a machine learning-based model for predicting the risk of early postoperative recurrence of hepatocellular carcinoma. Hepatocellular carcinoma (HCC), which is characterized by high incidence and mortality rates, remains a major global health challenge primarily due to the critical issue of postoperative recurrence. Early recurrence, defined as recurrence that occurs within 2 years posttreatment, is linked to the hidden spread of the primary tumor and significantly impacts patient survival. Traditional predictive factors, including both patient- and treatment-related factors, have limited predictive ability with respect to HCC recurrence. The integration of machine learning algorithms is fueled by the exponential growth of computational power and has revolutionized HCC research. The study by Zhang et al demonstrated the use of a groundbreaking preoperative prediction model for early postoperative HCC recurrence. Chall-enges persist, including sample size constraints, issues with handling data, and the need for further validation and interpretability. This study emphasizes the need for collaborative efforts, multicenter studies and comparative analyses to validate and refine the model. Overcoming these challenges and exploring innovative approaches, such as multi-omics integration, will enhance personalized oncology care. This study marks a significant stride toward precise, effi-cient, and personalized oncology practices, thus offering hope for improved patient outcomes in the field of HCC treatment.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/prevención & control , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/prevención & control , Neoplasias Hepáticas/cirugía , Algoritmos , Aprendizaje Automático , Oncología MédicaRESUMEN
INTRODUCTION AND OBJECTIVES: Due to organ shortages, liver transplantation (LT) using donation-after-circulatory-death (DCD) grafts has become more common. There is limited and conflicting evidence on LT outcomes using DCD grafts compared to those using donation-after-brain death (DBD) grafts for patients with hepatocellular carcinoma (HCC). We aimed to summarize the current evidence on the outcomes of DCD-LT and DBD-LT in patients with HCC. MATERIALS AND METHODS: Online databases were searched for studies comparing DCD-LT and DBD-LT outcomes in patients with HCC and a meta-analysis was conducted using fixed- or random-effects models. RESULTS: Five studies involving 487 (33.4%) HCC DCD-LT patients and 973 (66.6%) DBD-LT patients were included. The meta-analysis showed comparable 1-year [relative risk (RR)=0.99, 95%CI:0.95 to 1.03, p=0.53] and 3-year [RR=0.99, 95%CI:0.89 to 1.09, p=0.79] recurrence-free survival. The corresponding 1-year [RR=0.98, 95%CI:0.93 to 1.03, p=0.35] and 3-year [RR=0.94, 95%CI:0.87 to 1.01, p=0.08] patient survival and 1-year [RR=0.91, 95%CI:0.71 to 1.16, p=0.43] and 3-year [RR=0.92, 95%CI:0.67 to 1.26, p=0.59] graft survival were also comparable. There were no significant differences between the two cohorts regarding the tumor characteristics, donor/recipient risk factors and the incidence of post-operative complications, including acute rejection, primary non-function, biliary complications and retransplantation. CONCLUSIONS: Based on the current evidence, it has been found that comparable outcomes can be achieved in HCC patients using DCD-LT compared to DBD-LT, particularly when employing good quality graft, strict donor and recipient selection, and effective surgical management. The decision to utilize DCD-LT for HCC patients should be personalized, taking into consideration the risk of post-LT HCC recurrence. (PROSPERO ID: CRD42023445812).
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Muerte Encefálica , Carcinoma Hepatocelular , Neoplasias Hepáticas , Trasplante de Hígado , Humanos , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Supervivencia de Injerto , Obtención de Tejidos y Órganos , Donantes de Tejidos , Resultado del Tratamiento , Factores de RiesgoRESUMEN
OBJECTIVE: To evaluate for disparities in surgical care among US children with hepatoblastoma (HB) and hepatocellular carcinoma (HCC). STUDY DESIGN: In this retrospective National Cancer Database study (2004-2015), children aged <18 years with HB or HCC were included. Multivariable mixed-effects logistic regression was used to evaluate the association of sociodemographic factors (age, sex, race and ethnicity, insurance status, income, proximity to treating hospital) with the odds of undergoing surgical treatment after adjusting for disease-related factors (tumor size, metastasis, comorbidities) and hospital-level effects. Subgroup analyses by tumor histology were performed. RESULTS: A total of 811 children were included (HB: 80.9%; HCC: 19.1%), of which 610 (75.2%) underwent surgical treatment. Following adjustment, decreased odds of undergoing surgical treatment were associated with Black race (OR: 0.46 vs White, 95% CI [95% CI]: 0.26-0.80, P = .01), and having Medicaid (OR: 0.58 vs private, 95% CI: 0.38-0.88, P = .01) or no insurance (OR: 0.33 vs private, 95% CI: 0.13-0.80, P = .02). In children with HB, Black race was associated with decreased odds of undergoing surgical treatment (OR: 0.47 vs White, 95% CI: 0.25-0.89, P = .02). In children with HCC, Medicaid (OR: 0.10 vs private, 95% CI: 0.03-0.35, P < .001), or no insurance status (OR: 0.10 vs private, 95% CI: 0.01-0.83, P = .03) were associated with decreased odds of undergoing surgical treatment. Other than metastatic disease, no additional factors were associated with likelihood of surgical treatment in any group. CONCLUSIONS: Black race and having Medicaid or no insurance are independently associated with decreased odds of surgical treatment in children with HB and HCC, respectively. These children may be less likely to undergo curative surgery for their liver cancer.
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Carcinoma Hepatocelular , Disparidades en Atención de Salud , Hepatoblastoma , Neoplasias Hepáticas , Humanos , Hepatoblastoma/cirugía , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/patología , Masculino , Femenino , Niño , Estudios Retrospectivos , Preescolar , Lactante , Estados Unidos , Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Adolescente , Factores Sociodemográficos , Medicaid/estadística & datos numéricos , Factores Socioeconómicos , Bases de Datos FactualesRESUMEN
Hepatocellular carcinoma remains a significant worldwide malignancy and an important cause of cancer-related death. The incidence is increasing globally. In Latin America, there is no consistent data on the epidemiology of hepatocellular carcinoma. However, Brazil is considered a country with an intermediate incidence of this liver neoplasm. In the state of Ceará, situated in the northeast region of Brazil, there are no consistent clinical and epidemiologic data on the actual incidence and the treatment of hepatocellular carcinoma. The purpose of this article is to describe epidemiologic characteristics and treatment forms of patients with hepatocellular carcinoma who were treated in a Liver Transplant Center. A retrospective observational study was conducted using the database from the register of 299 patients with hepatocellular carcinoma between June 2004 and February 2022. Only patients born in Ceará were included. Therefore, most patients were eligible, based on the Milan Criteria, to undergo liver transplantation with a Model End Stage Liver Disease score of 12.48 ± 4.66 points, and the waiting list time was approximately 7 months with 8.7% hepatocellular carcinoma recurrence after liver transplant. A total of 38.5 % of cases were outside the Milan criteria at the time of cancer diagnosis, and transarterial chemoembolization was the main treatment choice. In conclusion, the diagnosis of hepatocellular carcinoma in Ceará mainly occurs in male patients with hepatitis C or alcoholism, with a mean age of 61.55 years and a previous diagnosis of liver disease. Liver transplantation was the best curative therapeutic form in patients with cirrhosis and hepatocellular carcinoma in Ceará, where a significant number of patients were diagnosed with intermediate and advanced-stage hepatocellular carcinoma, so public health policies are important for the screening and monitoring of liver disease.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Trasplante de Hígado , Humanos , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/cirugía , Brasil/epidemiología , Masculino , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Anciano , Quimioembolización Terapéutica , Incidencia , Listas de Espera , Adulto , Recurrencia Local de Neoplasia/epidemiologíaRESUMEN
BACKGROUND: To compare the efficacy and safety between emergency hepatectomy (EH) and emergency transarterial embolization (TAE) followed by staged hepatectomy (SH) in the treatment of spontaneous ruptured hepatocellular carcinoma (rHCC). METHODS: Databases (PubMed, EMBASE, Web of science, Cochrane Library, ClinicalTrial.gov, CNKI, Wanfang and VIP) were searched for all relevant comparative studies from January 2000 to October 2020. Odds ratio (OR) and mean difference (MD) with 95% confidence interval (CI) were pooled for dichotomous and continuous variables, respectively. Subgroup analyses based on the kind of embolization were conducted. RevMan 5.3 software was adopted for meta-analysis. RESULTS: Eighteen studies with 871 patients were finally included in this meta-analysis, 448 in EH group and 423 in TAE + SH group. No significant difference was observed in successful hemostasis (P = 0.42), postoperative hospital stay (P = 0.12), complication rate (P = 0.08) between EH and TAE + SH group. However, TAE + SH group was associated with shorter operating time (P < 0.00001), fewer perioperative blood loss (P = 0.007), fewer blood transfusion (P = 0.003), lower in-hospital mortality (P < 0.00001) and higher 1-year survival as well as 3-year survival (P < 0.0001; P = 0.003) compared with EH group. CONCLUSION: Compared with EH, TAE + SH could reduce perioperative operating time, blood loss, blood transfusion, mortality rate and increase the long-term survival rate of the rHCC patients, which may be a better treatment for resectable rHCC.
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Carcinoma Hepatocelular , Embolización Terapéutica , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/patología , Hepatectomía , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/patología , Rotura Espontánea/complicaciones , Rotura Espontánea/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world. Surgery is the treatment of choice in stages 0 and A in the Barcelona Clinic Liver Cancer classification. A minimally invasive technique in this scenario has the advantage of reducing postoperative pain, blood loss, and hospital stay. We present our experience and outcomes in laparoscopic liver resection in HCC. METHODS: Retrospective descriptive analysis from all patients who underwent laparoscopic liver resection for HCC in our center between August 2006 and December 2020. RESULTS: Laparoscopic liver resection for HCC was performed in 20 patients. The median age was 70 years, and the male gender was 75%. Sixteen patients had chronic liver disease, and 87.5% were Child A. The most common liver resection was the non-anatomical (45%). 30-day morbidity was 15%, without the need for reintervention. We had no 30-day mortality and postoperative liver failure. Negative margins were achieved in 90% of patients. Median disease-free survival and overall survival were 25 and 40.5 months, respectively. CONCLUSION: Laparoscopic liver resection for the treatment of HCC in our series is safe, with no 30-day mortality, low incidence of complications, no postoperative liver failure, and suitable medium- and long-term oncological results
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Laparoscopía/métodos , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/mortalidad , Hepatectomía/métodos , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento , Supervivencia sin Enfermedad , Tiempo de InternaciónRESUMEN
BACKGROUND: Left hepatic trisectionectomy consists of the removal of liver segments 2, 3, 4, 5, and 8. This difficult surgical procedure may be required when the left liver and right anterior sector (segments 5 and 8) are involved. We present a video of a robotic anatomic left trisectionectomy with Glissonian approach to the left and right anterior sector pedicles. METHODS: A 77-year-old man presented at a routine ultrasound with a large liver mass. Magnetic resonance imaging showed a bulky hepatocellular carcinoma occupying liver segments 2, 3, 4, 5, and 8, with a portal tumor thrombus in the right anterior sector. The patient had multiple comorbidities, including obesity, diabetes, hypertension, and coronariopathy. The multidisciplinary team decided to use immunotherapy with atezolizumab and bevacizumab. After 12 cycles, the patient showed an objective response, and left trisectionectomy was indicated. A robotic approach was proposed and consent was obtained. The Glissonian approach was used for anatomic control of the left and right anterior sector pedicles. RESULTS: The operative time was 390 min with an estimated blood loss of 410 ml, and no transfusion was required during or after the procedure. Recovery was uneventful and the patient was discharged on postoperative day 8. No bile leak was observed, and the drain was removed on postoperative day 8. CONCLUSIONS: Robotic left trisectionectomy is safe and feasible. The Glissonian approach is useful for anatomic left liver trisectionectomy. This video can help gastrointestinal surgeons perform this complex procedure in a minimally invasive manner.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Procedimientos Quirúrgicos Robotizados , Masculino , Humanos , Anciano , Hepatectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Neoplasias Hepáticas/cirugía , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/cirugíaRESUMEN
INTRODUCTION AND OBJECTIVES: The occurrence of hepatocellular carcinoma (HCC) is not entirely clear at present. This study comprehensively described the landscape of genetic aberrations in Chinese HCC patients using next-generation sequencing (NGS) and investigated the association of genetic aberrations with clinicopathological characteristics and prognosis. MATERIALS AND METHODS: The clinicopathological data of 78 HCC patients undergoing surgery were retrospectively analyzed. The genomic DNA extracted from tumor samples was detected using a NGS-based gene panel. RESULTS: Mutations in TP53 (55%), TERT (37%), MUC16 (29%) and CTNNB1 (27%) were most common in HCC. The co-occurrences between frequently mutated genes occurring ≥10% were relatively common in HCC. Forty-eight (61.5%) cases harbored DNA damage repair gene mutations, mainly including PRKDC (11.5%), SLX4 (9.0%), ATM (7.7%), MSH6 (7.7%), and PTEN (6.4%), and 39 (50.0%) patients had at least one actionable mutation. FH amplification (odds ratio: 3.752, 95% confidence interval: 1.170-12.028, p=0.026) and RB1 mutations (odds ratio: 13.185, 95% confidence interval: 1.214-143.198, p=0.034) were identified as the independent risk factors for early postoperative recurrence in HCC. CONCLUSIONS: Our study provides a novel insight into the genomic profiling of Chinese HCC patients. FH amplification and RB1 mutations may be associated with an increased risk of early postoperative recurrence in HCC.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/patología , Pueblos del Este de Asia , Estudios Retrospectivos , Genómica , Mutación , Pronóstico , Secuenciación de Nucleótidos de Alto RendimientoRESUMEN
PURPOSE: Locoregional therapies (LRT) are employed for bridging patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT). Although the main LRT options include transarterial chemoembolization (TACE) and radiofrequency ablation (RFA), percutaneous ethanol injection (PEI) is an alternative with considerably lower costs. This study is a pioneering evaluation of the natural history of PEI bridging to OLT as compared to TACE. METHODS: All consecutive cirrhotic patients with HCC enlisted for OLT (2011-2020) at a single center were analyzed. Patients were divided into three LRT modality groups: PEI, TACE, and PEI+TACE. The primary study outcome was waitlist dropout due to tumor progression beyond Milan criteria. A comparison of post-transplant outcomes of patients as stratified by LRT modality also was performed. RESULTS: One hundred twenty-nine patients were included (PEI=56, TACE=43, PEI+TACE=30). The dropout rate due to tumor progression was not different among the three groups: PEI=8.9%, TACE=14%, PEI+TACE=16.7% (p=0.54). Thirteen (76.4%) patients underwent OLT after successful downstaging (3 [75%] in the PEI group, 5 [83.3%] in the TACE group, and 5 [71.4%] in the PEI+TACE group). For the 96 patients undergoing OLT, 5-year post-transplant recurrence-free survival was PEI=55.6% vs. TACE=55.1% vs. PEI+TACE=71.4% (p=0.42). Complete/near-complete pathological response rate was similar among groups (p=0.82). CONCLUSION: Dropout rates and post-transplant recurrence-free survivals related to PEI were comparable to those of TACE. This study supports the use of PEI alone or in combination with TACE for HCC patients awaiting OLT whenever RFA is not an option.
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Carcinoma Hepatocelular , Ablación por Catéter , Quimioembolización Terapéutica , Neoplasias Hepáticas , Trasplante de Hígado , Humanos , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , Quimioembolización Terapéutica/efectos adversos , Etanol , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
INTRODUCTION AND OBJECTIVES: Large primary hepatocellular carcinoma (HCC) has a high mortality rate and a variety of treatments. Surgery and transcatheter arterial chemoembolization (TACE) are important treatments. Which could be better remain debatable. The objective of the study is to compare the long-term overall survival of surgical resection (SR) and the use of TACE in patients with large hepatocellular carcinoma. MATERIALS AND METHODS: We assessed clinical trials through PubMed, Medline, Embase, and the Cochrane Library up to March 2022. Two researchers independently screened articles, extracted data, and assessed the study quality according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)guidelines. The primary outcome was overall survival (OS). The secondary outcomes were OS after propensity scores matching (PSM) and progression-free survival (PFS). RESULTS: A total of 14 studies, including 3609 patients, were enrolled in the meta-analysis. The meta-analysis indicated a significant improvement in the 1-year OS, 3-year OS, and 5-year OS favoring SR over TACE (OR = 2.19, 95% CI 1,60-3.00; OR = 3.47, 95% CI 2.47-4.88; OR = 2.72, 95% CI 2.03-3.64, p < 0.001, random model). The results were consistent across subgroups of tumor size and tumor numbers (p > 0.05). The pooled outcome indicated that 1-year OS, 3-year OS, and 5-year OS after PSM were higher in the SR group than in the TACE group (p < 0.001). CONCLUSIONS: This meta-analysis indicates that among patients with large primary hepatocellular carcinoma, the overall survival rate of patients undergoing surgical resection was higher than that of patients undergoing TACE.
Asunto(s)
Carcinoma Hepatocelular , Quimioembolización Terapéutica , Hepatectomía , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Supervivencia sin ProgresiónRESUMEN
BACKGROUND: Defining patterns and risk of recurrence can help inform surveillance strategies and patient counselling. We sought to characterize peak hazard rates (pHR) and peak time of recurrence among patients who underwent resection of hepatocellular carcinoma (HCC). METHODS: 1434 patients who underwent curative-intent resection of HCC were identified from a multi-institutional database. Hazard, patterns, and peak rates of recurrence were characterized. RESULTS: The overall hazard of recurrence peaked at 2.4 months (pHR: 0.0384), yet varied markedly. The incidence of recurrence increased with Barcelona Clinic Liver Cancer (BCLC) stage 0 (29%), A (54%), and B (64%). While the hazard function curve for BCLC 0 patients was relatively flat (pHR: <0.0177), BCLC A patients recurred with a peak at 2.4 months (pHR: 0.0365). Patients with BCLC B had a bimodal recurrence with a peak rate at 4.2 months (pHR: 0.0565) and another at 22.8 months. The incidence of recurrence also varied according to AFP level (≤400 ng/mL: 52.6% vs. >400 ng/mL: 36.3%) and Tumor Burden Score (low: 73.7% vs. medium: 50.6% vs. high: 24.2%) (both p < 0.001). CONCLUSION: Recurrence hazard rates for HCC varied substantially relative to both time and intensity/peak rates. TBS and AFP markedly impacted patterns of hazard risk of recurrence.
Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , alfa-Fetoproteínas , Hepatectomía , Estadificación de Neoplasias , Estudios Retrospectivos , Recurrencia Local de Neoplasia/patologíaRESUMEN
RATIONALE AND OBJECTIVES: The aim of the current study was to investigate whether hypointense hepatocellular carcinoma (HCC) in the hepatobiliary phase (HBP) on gadoxetic acid-enhanced MRI at pretreatment is a potential prognostic marker for tumor recurrence within 3 years after surgery conducted for a curative purpose (resection or liver transplantation). MATERIALS AND METHODS: Systematic review was performed in the PubMed, Embase, Cochrane Library, and LILACS databases. Original articles focused on evaluating HCC signal intensity (SI) in HBP, as well as recurrence at least 3 years after surgery were included in the study. Odds ratio (OR) was measured based on the inverse variance method and the random-effects model. The Quality in Prognosis Studies (QUIPS) tool was used to assess the quality of the included articles. RESULTS: Five studies with 718 patients, in total, were analyzed. The odds ratio of disease recurrence in patients with hypointense HCC in the HBP, within 3 years after surgery, was 3.12 times higher than that observed in patients with hyperintense HCC in the HBP (OR 3.12; 95% CI 1.27-7.68; p = 0.01). Heterogeneity was classified as intermediate (I2 = 52%). Articles included in the review overall presented a low risk of bias. CONCLUSION: Hypointense HCC in the HBP on gadoxetic acid-enhanced MRI at pretreatment has increased the likelihood of tumor recurrence in patients subjected to resection or liver transplantation. HCC SI in the HBP is a potential non-invasive imaging biomarker associated with patient prognosis.
Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/patología , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/cirugía , Medios de Contraste , Gadolinio DTPA , Imagen por Resonancia Magnética/métodos , Estudios RetrospectivosRESUMEN
BACKGROUND: Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world. Surgery is the treatment of choice in stages 0 and A in the Barcelona Clinic Liver Cancer classification. A minimally invasive technique in this scenario has the advantage of reducing postoperative pain, blood loss, and hospital stay. We present our experience and outcomes in laparoscopic liver resection in HCC. METHODS: Retrospective descriptive analysis from all patients who underwent laparoscopic liver resection for HCC in our center between August 2006 and December 2020. RESULTS: Laparoscopic liver resection for HCC was performed in 20 patients. The median age was 70 years, and the male gender was 75%. Sixteen patients had chronic liver disease, and 87.5% were Child A. The most common liver resection was the non-anatomical (45%). 30-day morbidity was 15%, without the need for reintervention. We had no 30-day mortality and postoperative liver failure. Negative margins were achieved in 90% of patients. Median disease-free survival and overall survival were 25 and 40.5 months, respectively. CONCLUSION: Laparoscopic liver resection for the treatment of HCC in our series is safe, with no 30-day mortality, low incidence of complications, no postoperative liver failure, and suitable medium- and long-term oncological results.