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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Primary Liver Cancer - October 2002
National Cancer Institute®
Last Modified: October 1, 2002
- Ultrasonic aspiration hepatectomy for 136 patients with hepatocellular carcinoma.
- [Towards early screening and treatment of hepatocellular carcinoma cirrhosis?]
- [Practical screening and early treatment of hepatocellular carcinoma. Results of a French survey]
- Risk factors for morbidity following liver surgery.
- Liver regeneration after anatomical resections.
- Hepatic tumors and oral contraceptives: surgical management.
- [Hepatocellular carcinoma]
- The European approach to hepatocellular carcinoma.
- Methods and related drawbacks in the estimation of surgical risks in cirrhotic patients undergoing hepatectomy.
- Ultrasound-guided liver resections for hepatocellular carcinoma.
- Limits and benefits of exclusive transthoracic hepatectomy approach for patients with hepatocellular carcinoma.
- Remodeling the surgical approach to hepatocellular carcinoma.
- Resection of hepatocellular carcinoma: a European experience on 328 cases.
- Liver transplantation for hepatocellular carcinoma.
- Reasons for an exchange between eastern and western approach to patients with HCC.
- Hepatocellular Carcinoma: Eastern and Western Experiences. Proceedings of an international congress. Tokyo, Japan, December 9, 2000.
- Perspectives and drawbacks of minimally invasive surgery for hepatocellular carcinoma.
- Treatment of hepatocellular carcinoma by percutaneous interventional methods.
- Prognosis of hepatocellular carcinoma.
- Transcatheter arterial chemoembolization of hepatocellular carcinoma: a Japanese experience.
- Hepatic artery chemoembolization for advanced stage HCC: experience of 650 patients.
- Prevention of hepatocellular carcinoma recurrence: actuality and perspectives.
- Computer-aided hepatic tumour ablation: requirements and preliminary results.
- [Present status and evaluation of interventional therapy for primary hepatocellular carcinoma]
- [Prognostic factors influencing survival in patients with large hepatocellular carcinoma receiving combined transcatheter arterial
- [Hyperthermal lipiodol embolization and thermocoagulation for the treatment of primary hepatocellular carcinoma]
- Radiofrequency thermal ablation for treatment of hepatocellular carcinoma.
- 131I lipiodol therapy for unresectable hepatocellular carcinoma.
- Modern treatment of childhood hepatoblastoma: what do clinicians and pathologists have to say to each other?
- Chemotherapy for suspected hepatoblastoma without efforts at surgical resection is a bad practice.
- [Clinical study on effect of Chinese herbal medicine on liver damage caused by hepatic artery chemoembolization]
- Combination of transcatheter arterial chemoembolization using cisplatin-lipiodol suspension and percutaneous ethanol injection for
- Orthotopic liver transplantation for unresectable hepatoblastoma.
- Vertical portal vein clamping in right hepatic lobectomy for live donation or neoplasm.
- Radiation-induced liver disease after radiotherapy for hepatocellular carcinoma: clinical manifestation and dosimetric description.
- Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: analysis of 48 cases.
- Delta-aminolevulinic acid cytotoxic effects on human hepatocarcinoma cell lines.
- The effect of different interventional treatment on P-Glycoprotein in different histopathological types and grades of primary hepatocellular
- Japanese approach to hepatocellular carcinoma.
- Surgical treatment of hepatocellular carcinoma in cirrhosis.
- Neoadjuvant and adjuvant therapy for resectable hepatocellular carcinoma: review of the randomised clinical trials.
- [Clinical outcome of a cohort of 63 patients with hepatocellular carcinoma treated with octreotide.]
- Stepwise hook extension technique for radiofrequency ablation therapy of hepatocellular carcinoma.
Table of Contents
1
UI - 12174393
AU - Wu W; Lin XB; Qian JM; Ji ZL; Jiang Z
TI -
Ultrasonic aspiration hepatectomy for 136 patients with hepatocellular
carcinoma.
SO - World J Gastroenterol 2002 Aug;8(4):763-5
AD - Institute of Acoustics,Ultrasonic Medical Electronics Research Group
State Key Laboratory of Modern Acoustics, Nanjing University, Nanjing
210093, Jiangsu Province, China. weiwu-cs@sohu.com
AIM:To study the operative injury, post-operative complications, the
hospitalization time, the post-operative survival rate of ultrasonic
aspiration hepatectomy with a domestic new type of ultrasonic surgical
device in comparison with that of conventional techniques of
hepatectomy. METHODS: A total 136 patients with hepatocellular carcinoma
(HCC, including 12 patients in 1991 and 124 consecutive patients from
resection (group T) and 179 HCC patients received conventional
hepatectomy during the corresponding period (group C). The results of
the two groups were compared statistically. RESULTS: There was no
significant difference in the mean operation time between group T
(152+/-11 min) and C (144+/-11 min). No operation or hospital death
occurred in both groups. In group T, the mean volumes of bleeding
(463+/-15 ml) and blood transfusion (381+/-12 ml) were markedly less
than those in group C (557+/-20 ml, and 507+/-18 ml, respectively,
P<0.05). The mean hospitalization time of group T (8.9+/-0.6 d) was
markedly shorter than that of group C (11.7d+/-0.6 d) (P<0.05). The
incidence of complications in group T was markedly lower than in group
C, post-operative jaundice occurred in 4/136 and 31/179, respectively
(P<0.05), liver failure in 0/136 and 2/179, cholorrhea in 0/136 and
6/179, hydrothorax in 21/136 and 39/179 (P<0.05), ascices in 9/136 and
54/179, respectively (P<0.05 ). There was no significant difference in
the 1-year survival rate between the two groups (P>0.05), while the
3-year survival rate of group T (64.2 % ) increased markedly as compared
with that of group C (55.7 %) (P<0.01). CONCLUSION: The ultrasonic
aspiration hepatectomy with a domestic new type of ultrasonic surgical
device could evidently reduce the operative injury and post-operative
complications, shorten the hospitalization time and prolong the
survivals of HCC patients.
2
UI - 12193853
AU - Roudot-Thoraval F; Dhumeaux D
TI -
[Towards early screening and treatment of hepatocellular carcinoma
cirrhosis?]
SO - Gastroenterol Clin Biol 2002 Jun-Jul;26(6-7):559-60
3
UI - 12193855
AU - Ganne-Carrie N; Chevret S; Barbare JC; Chaffaud C; Grando V; Vogt AM;
TI -
Beaugrand M; Trinchet JC; et l'Association Francaise pour l'Etude du
Foie (2) et l'Association Nationale des Gastroenterologues des Hopitaux
generaux
[Practical screening and early treatment of hepatocellular carcinoma.
Results of a French survey]
SO - Gastroenterol Clin Biol 2002 Jun-Jul;26(6-7):570-7
AD - Service d'Hepato-Gastroenterologie, Hopital Jean Verdier (AP-HP,
Universite Paris 13), Bondy 93140, France.
nathalie.ganne@jvr.ap-hop-paris.fr
AIM: To describe French practices for screening hepatocellular
carcinoma. METHODS: A standardized questionnaire was mailed to all
out of 623 practitioners responded (66%). 394 (96%) routinely screen
hepatocellular carcinoma, mainly with ultrasound (98%) and mainly at
6-month intervals (77%). Screening was performed in cirrhosis (100%) or
extensive fibrosis (54%), independent of the etiology (21%) or the
Child-Pugh score of the chronic liver disease (41%), but based on age
and treatment feasibility. If of a small hypoechogenic nodule was
detected in a young patient with compensated HCV-cirrhosis, 59% of
practitioners performed a histological examination. In case of non
biopsy-proven hepatocellular carcinoma, a second biopsy (49%), treatment
(either percutaneous alcohol injection, resection or transplantation)
(24%) or an ultrasonographic follow-up (23%) was proposed. In case of
biopsy-proven hepatocellular carcinoma, resection (49%), transplantation
(30%) or percutaneous alcohol injection (16%) was proposed. CONCLUSION:
Almost all French specialists routinely screen cirrhotic patients for
hepatocellular carcinoma, but use somewhat different modalities. In case
of small HCC without contraindications to curative treatment, surgical
resection is performed in half the patients.
4
UI - 12211740
AU - Szubert A; Sarzynski J; Biejat Z; Uryzek M; Grous A; Kowalik I; Polanski
TI -
JA
Risk factors for morbidity following liver surgery.
SO - Med Sci Monit 2001 May;7 Suppl 1():294-7
AD - 3rd Department of Surgery, 2nd Faculty of Medicine, Medical University
in Warsaw, ul. Stepinska 19/25, Warsaw, Poland.
The aim of this study is to define risk factors for severe complications
following anatomical liver resections. The study material consists of
the first 50 patients (26 women, 24 men, at mean age 50.6 years) treated
at 3rd Department of Surgery 2nd Faculty of Medicine, Medical University
in Warsaw. The indications for resection included benign neoplasm in 19
cases and malignancy in 31 cases. All the patients underwent anatomical
liver resection in accordance with Couinaund's segmental division. In
order to define prognostic factors for severe postoperative
complications, a multi-factor statistical analysis was conducted. The
following parameters were analysed: patient's age, the levels of
bilirubin, total protein, albumin, prothrombin time, kaolin-kephalin
time, range of resection and blood loss during operation. Eleven
patients (22%) died in postoperative period. In 8 cases the death was
caused by liver failure. Statistical analysis showed that blood loss,
albumin level on fifth postoperative day and kaolin-kephalin time before
and after surgery are independent risk factors predisposing to the
development of complications.
5
UI - 12211741
AU - Szubert A; Zajac L; Walski M; Faryna M; Biejat Z; Polanski J
TI -
Liver regeneration after anatomical resections.
SO - Med Sci Monit 2001 May;7 Suppl 1():298-300
AD - 3rd Department of Surgery, 2nd Faculty of Medicine, Medical University
in Warsaw, ul. Stepinska 19/25, Warsaw, Poland.
BACKGROUND: The authors present the results of investigation of liver
regeneration after partial parenchyma resection. MATERIAL AND METHODS:
20 patients (16 females, 4 male) aged 31-67 years were operated on
because of metastatic colon cancer (7 cases), cavernous hemangioma (6
cases), hepatocellular carcinoma (1), alveococcosis (2), metastases of
malignant melanoma (1), gall bladder carcinoma (1), FNH (1) and mucous
cystadenocarcinoma (1). The resection according to anatomical segments
by Couinaud were performed. Spiral CTs including liver volumetry were
taken before and 30 days after the operation. on the 7-th day after the
surgery, liver biopsy was performed and the material was examined under
light and electron microscope. RESULTS: There was no postoperative
mortality. We observed transient elevation of transaminases, bilirubin
levels and decrease of albumin level. Control spiral CT revealed
increased liver volume in 15 cases (75 percent). In 16 cases (80
percent), electron microscopy investigations showed regeneration of the
liver (mitotic figures). CONCLUSIONS: Our material shows that
hyperplasia as well as blood vessel and bile duct neogenesis play a very
important role in liver regeneration process.
6
UI - 3001424
AU - Gonzalez F; Marks C
TI -
Hepatic tumors and oral contraceptives: surgical management.
SO - J Surg Oncol 1985 Jul;29(3):193-7
The clinical and pathological features of 14 patients with benign liver
tumors are reviewed. There were two males and 12 females in this series
of cases. All but one of the females had been on contraceptive steroid
therapy for an average of 7.8 years. Abdominal pain was the presenting
complaint in 75% of cases, a palpable abdominal mass was present in 22%,
while 12.5% of the patients presented with acute hemorrhagic shock due
to rupture of a liver cell adenoma. Liver cell adenomas (LCA) were found
in 87.5% of the cases and a diagnosis of focal nodular hyperplasia (FNA)
was made at histologic examination of the resected tumors in 12.5% of
cases. Surgical resection of the liver tumors was performed successfully
in 89% of the cases. Hepatic lobectomy was accomplished in four
patients, hepatic segmentectomy was possible in three cases, while local
wedge resection or focal excision were indicated on seven occasions.
There was no operative mortality in this series, but one patient
required reoperation for drainage of a complicating subphrenic abscess.
7
UI - 2461847
AU - Habscheid W
TI -
[Hepatocellular carcinoma]
SO - Dtsch Med Wochenschr 1988 Dec 9;113(49):1926-31
AD - Medizinische Universitatsklinik Wurzburg.
8
UI - 11941934
AU - Colombo M; Sangiovanni A
TI -
The European approach to hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):12-6
AD - Division of Hepatology, IRCCS Maggiore Hospital, University of Milan,
Milan, Italy. massimo.colombo@unimi.it
Patients with cirrhosis of viral, metabolic or autoimmune origin are at
high risk of developing hepatocellular carcinoma. Prospective
surveillance based on semi-annual ultrasound examination of the abdomen
has allowed for detection of small tumors in many patients, but it is
not clear whether liver-related mortality was decreased in parallel.
Prognostication in patients with hepatocellular carcinoma requires
integrated assessment of tumor size and number, liver function and
performance status. The therapeutic approach is to a large extent
non-evidence based and the best treatment choice depends on individual
patients characteristics, taking into account the local technological
and therapeutic resources and skills. Since surgical resection, liver
transplantation and percutaneous ablation have achieved a high rate of
complete response in properly selected patients, these procedures are
considered curative treatments. Being curative treatments applicable
only to patients with a small tumor, hepatocellular carcinoma
surveillance aimed at early detection of the tumor is the most practical
approach for improving treatment outcome.
9
UI - 11941945
AU - Fan ST
TI -
Methods and related drawbacks in the estimation of surgical risks in
cirrhotic patients undergoing hepatectomy.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):17-20
AD - Department of Surgery, University of Hong Kong, Queen Mary Hospital, 102
Pokfulam Road, Hong Kong. hrmsfst@hkucc.hku.hk
There has been a dramatic improvement in recent results of hepatectomy
for hepatocellular carcinoma in cirrhotic patients. Hospital mortality
rates of less than 5% are frequently reported. The improvement is
largely a result of better techniques and performance of surgeons in
hepatectomy, and reduction in blood loss and transfusion requirement.
Better selection of patients is perhaps a more significant contributory
factor. Careful identification of risk factors related to the medical
condition of the patient, functional reserve of the liver and volume of
the remnant liver is essential for the prevention of postoperative liver
failure. Indocyanine green clearance test is the most accurate test for
assessment of liver function reserve. An indocyanine green retention
rate of 14% at 15 minutes is the safety limit for major hepatectomy for
cirrhotic patients. A maximum of 60% of the nontumorous liver can be
resected safely. Computed tomography is therefore an important
assessment parameter. The liver function reserve also reveals the
suitability for hepatectomy. Liver enzymes, alanine aminotransferase or
aspartate aminotransferase can reflect the hepatic activity, which could
be responsible for the impaired liver function. Steatosis is another
factor that influences hepatic function reserve. Age is also an
important risk factor in hepatectomy because elderly patients may harbor
occult heart disease, reduced respiratory and liver function reserves.
After recognizing the risk factors, surgeons should eliminate operative
morbidity and mortality by making appropriate decisions based on the
assessments. In conclusion, preoperative risk assessment involves
evaluation of hepatic function reserve, remnant liver volume, liver
status, age and the medical condition of the patient. A 0% hospital
mortality rate is considered the objective.
10
UI - 11941957
AU - Torzilli G; Leoni P; Gendarini A; Calliada F; Olivari N; Makuuchi M
TI -
Ultrasound-guided liver resections for hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):21-7
AD - Liver Surgery Unit, Reparto di Chirurgia Generale 1 Ospedale Maggiore di
Lodi, Azienda Sanitaria Locale della Provincia di Lodi Largo Donatori di
Sangue, 2, I-26900, Lodi, Italy. torzillg@tin.it
Imaging-guided interventional procedures have modified the approach to
hepatocellular carcinoma including the surgical one. In fact, liver
resections can be carried out with no mortality even if cirrhosis is
associated, combining the needs for oncological radicality and liver
parenchyma sparing mainly because of the extensive use of intraoperative
ultrasonography either for tumor staging or resection-guidance. The aid
of intraoperative ultrasonography is therefore optimizing the balance
between the oncological radicality and the sparing of the highest amount
of functioning liver parenchyma. Intraoperative ultrasonography allows
the accomplishment of anatomical resections otherwise not possible such
as the systematic segmentectomy. This is of crucial importance if taking
into account that anatomical resections seem able to provide better
prognosis than the non-anatomical one. However, if non-anatomical
resection is carried out intraoperative ultrasonography guidance allows
a better tumor clearance. Precise definition of hepatic vein anatomy and
association with color Doppler enables hepatectomies otherwise not
possible, expanding the indication at surgical resection. In conclusion,
we can affirm that liver resection is an imaging-guided procedure and as
every interventional imaging-guided procedure, its features are the
highest therapeutic efficacy combined with the minimal invasiveness.
Then, with the intraoperative ultrasonography guidance liver resection
remains the treatment of choice of hepatocellular carcinoma.
11
UI - 11941979
AU - Pocard M; Sauvanet A; Regimbeau JM; Duwat O; Farges O; Belghiti J
TI -
Limits and benefits of exclusive transthoracic hepatectomy approach for
patients with hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):32-5
AD - Department of Digestive Surgery, Hopital Beaujon, Clichy, France.
BACKGROUND/AIMS: The purpose of this study was to evaluate the results
of liver resection in cirrhotic patients for liver hepatocellular
carcinoma located near the diaphragm through an exclusive transthoracic
approach. METHODOLOGY: Between 1995 and 1999, 19 cirrhotic patients with
hepatocellular carcinoma underwent a liver resection through an
exclusive transthoracic approach. This approach was indicated in 11
cases for previous upper abdominal surgery, including hepatobiliary
surgery in 3 and before liver transplantation in 8. Results of the
transthoracic approach were compared to 84 cirrhotic patients who
underwent transabdominal limited resection of hepatocellular carcinoma
matched for age, sex and localization of the tumor. RESULTS: Resection
was feasible by an exclusive transthoracic approach in 18 (95%) cases
with a mean operating time of 201 +/- 53 min. In 8 (44%) patients a
Pringle maneuver was performed. No postoperative deaths were observed
after the transthoracic approach. Pulmonary complications rate was
significantly higher (P < 0.001) after transthoracic resection compared
to transabdominal resection (67% vs. 25%, P < 0.001). In contrast,
ascites were observed in only one (5%) of the transthoracic group
compared to 35 (42%) in the transabdominal group (P < 0.01). The
resection margin was positive in 3 (17%) after transthoracic approch and
in 1 (2%) patient after the transabdominal resection (P < 0.02). In
patients who underwent liver transplantation after the transthoracic
approach, total hepatectomy was performed without increasing
difficulties. CONCLUSIONS: The transthoracic approach is a safe
procedure for resection of hepatocellular carcinoma located under the
right diaphragm in cirrhotic patients. However, this approach allows
only limited resection with a high risk of positive margin, resulting in
a restriction of indications either for patients with previous major
abdominal surgery than before liver transplantation.
12
UI - 11941980
AU - Makuuchi M
TI -
Remodeling the surgical approach to hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):36-40
AD - Division of Hepato-Biliary-Pancreatic and Transplantation Surgery,
Department of Surgery, Graduate School of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033. makuuchi-tky@umin.ac.jp
Surgery for hepatocellular carcinoma has improved during the last two
decades, and the improvement is mainly attributable to various
innovations in liver surgery, such as establishment of the precise
criteria for surgical indications, development of ultrasound-guided
hepatectomy, and additional use of portal vein embolization. Operative
mortality has fallen below 2% in the 1990's, and the 5-year survival
rate reached, according to the results of a nationwide survey, nearly
50%. More than 90% of the hepatectomies in the authors' institution are
performed without whole blood transfusion, and mean hospital stay is
approximately 23 days. Moreover, no-mortality hepatectomy has been
achieved since 1993.
13
UI - 11941981
AU - Belghiti J; Regimbeau JM; Durand F; Kianmanesh AR; Dondero F; Terris B;
TI -
Sauvanet A; Farges O; Degos F
Resection of hepatocellular carcinoma: a European experience on 328
cases.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):41-6
AD - Department of Hepatobiliary and Digestive Surgery, Beaujon Hospital,
Paris VII University, Clichy, France. j.bel@bjn.ap-hop-paris.fr
BACKGROUND/AIMS: Surgical liver resection has been demonstrated in Asian
countries to be the best therapeutic option in patients with
hepatocellular carcinoma. Because the value of this treatment is still
debated in Western countries, the aim of this paper was to report a
European experience of resection for hepatocellular carcinoma.
METHODOLOGY: From 1990 to 1999, 239 men and 61 women aged from 15 to 77
years old underwent 328 resections including major resection in 138
(42%) cases. Normal liver was present in 53 patients (17%) and chronic
liver disease was present in 247 including 152 (50%) with cirrhosis.
RESULTS: In-hospital mortality was 6.4% and was significantly influenced
by the presence of chronic liver disease (1.7% vs. 7.4%). Mortality
after resection in alcoholic patients (14%), in patients with hepatitis
C (9%) was significantly higher than in patients chronic hepatitis B
(1%) (P < 0.05). The overall survival rates were 81%, 57%, 37%, and 13%
at 1, 3, 5 and 10 years. Five-year survival rate was significantly
higher (P < 0.05) in patients with normal liver as compared to chronic
liver disease (50% vs. 34%). In patients with chronic liver disease
parameters, which significantly influenced survival rate, were vascular
invasion, tumor differentiation and the extent of resection.
CONCLUSIONS: In this European study with varied profile of etiologies
associated with hepatocellular carcinoma we showed that a five-year
survival rate of 40% can be expected after resection and that chronic
liver disease is a major factor influencing short and long-term
prognosis.
14
UI - 11941982
AU - Durand F; Belghiti J
TI -
Liver transplantation for hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):47-52
AD - Department of Hepatology, Hopital Beaujon, Clichy, France.
Liver transplantation has become the best option in patients with
decompensated cirrhosis and a small hepatocellular carcinoma. Indeed,
because of the severity of cirrhosis, resection is usually impossible
and in addition, transplantation provides survival rates close to those
obtained in cirrhotic patients without malignancy (70 to 80% 3-year
survival rate). In patients with a small hepatocellular carcinoma and
compensated cirrhosis, both resection and transplantation can be
performed. Because of the scarcity of donors, there have been
reservations concerning transplantation in patients who otherwise could
have undergone resection. However, there is increasing evidence that
long-term results of transplantation are significantly superior to those
of resection. Therefore, patients with a small hepatocellular carcinoma
and compensated cirrhosis are increasingly considered as suitable
candidates for transplantation. In contrast to cirrhotic patients with a
small hepatocellular carcinoma, patients with large and/or multifocal
tumors should no longer be transplanted because of a high rate of early
recurrence and the accelerated course of tumor progression due to
immunosuppression, both factors being the source of poor results. On
rare occasions, hepatocellular carcinoma develops in patients without
underlying liver disease. In such cases the tumor is usually recognized
when it is large and symptomatic. The absence of underlying liver
lesions offers the possibility of extended resection. However, in case
of nonresectable (bilobar) tumors or limited recurrence after resection,
transplantation may be considered due to the slow progression this
subtype of hepatocellular carcinoma. Whatever the underlying liver
parenchymal status, efforts should be made to reduce the risk of
recurrence.
15
UI - 11941983
AU - Makuuchi M; Belghiti J; Torzilli G
TI -
Reasons for an exchange between eastern and western approach to patients
with HCC.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):5-6
16
UI - 12356006
AU - Anonymous
TI -
Hepatocellular Carcinoma: Eastern and Western Experiences. Proceedings
of an international congress. Tokyo, Japan, December 9, 2000.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):5-95
17
UI - 11941985
AU - Montorsi M; Santambrogio R; Bianchi P; Dapri G; Spinelli A; Podda M
TI -
Perspectives and drawbacks of minimally invasive surgery for
hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):56-61
AD - Department of Surgery, University of Milan, Ospedale S. Paolo, Milano,
Italy. marco.montorsi@unimi.it
The need for an accurate intrahepatic staging is crucial for patients
with hepatocellular carcinoma candidates to an aggressive surgical or
ablative treatment. Currently available data indicate that laparoscopy
with laparoscopic ultrasound provides information similar to that
obtained by intraoperative ultrasound and it is able to identify small
intrahepatic lesions not diagnosed by preoperative imaging techniques.
Furthermore, laparoscopy with laparoscopic ultrasound also allows
performance of ultrasound-guided biopsies or interstitial therapies as
ethanol injection, cryoablation or radiofrequency thermal ablation in
the same session. A laparoscopic segmentectomy or subsegmentectomy is
technically feasible and safe in selected patients with small peripheral
tumors. Combinations of resection and ablation may be required in
certain cases, extending the indications for the laparoscopic approach
to hepatocellular carcinoma in liver cirrhosis. The AA review the
technical issues and the preliminary results of their experience in the
field of minimally invasive approach to hepatocellular carcinoma. On the
basis of these preliminary findings, laparoscopy with laparoscopic
ultrasound seems to be useful to identify unsuspected new nodules and to
help in choosing the most suitable treatment. In case of hepatocellular
carcinoma not amenable to surgical resection, laparoscopic
radiofrequency represents a safe and effective treatment above all when
the percutaneous approach is difficult or impossible. Furthermore,
laparoscopy with laparoscopic ultrasound could represent a sound
preliminary examination in patients who are candidates to liver
transplantation in order both to improve the staging and to guide an
interstitial therapy as a bridge to the transplantation itself.
18
UI - 11941986
AU - Livraghi T; Meloni F
TI -
Treatment of hepatocellular carcinoma by percutaneous interventional
methods.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):62-71
AD - Department of Radiology, Ospedale Civile, via Cereda 23, 20059
Vimercate, Milan, Italy. lalivra@tin.it
In the treatment of early and intermediate hepatocellular carcinoma the
range of indications for percutaneous ablation techniques is becoming
wider than surgery or intra-arterial therapies. Indeed, whereas for some
years only patients with up to three small tumors were treated, with the
introduction of the single-session technique performed under general
anesthesia, even patients with more advanced disease are now being
treated. Although it is understood that partial resection assures the
highest local control, the survival rates after surgery are roughly
comparable with percutaneous ethanol injection. The explanation is due
to a balance among advantages and disadvantages of the two therapies.
Percutaneous ethanol injection survival curves are better than curves of
resected patients who present adverse prognostic factors, and this means
that surgery needs a better selection of the patients. Indications for
both of these therapies are reported. An open question remains about the
choice between percutaneous ethanol injection and other new ablation
procedures. In our department we currently use radiofrequency ablation
in the majority of patients but consider percutaneous ethanol injection
and segmental transarterial chemoembolization complementary, and use
them according to the features of the disease and the response.
Evaluation of their therapeutic efficacy, techniques and results are
reported.
19
UI - 11941987
AU - Llovet JM; Fuster J; Bruix J
TI -
Prognosis of hepatocellular carcinoma.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):7-11
AD - Barcelona-Clinic Liver Cancer (BCLC) Group, Liver Unit, Institut de
Malalties Digestives, Hospital Clinic Institut d'Investigacions
Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona,
Catalonia, Spain.
The prognosis of patients with hepatocellular carcinoma is related to
the stage of the tumor at diagnosis and to the degree of liver function
impairment induced either by the tumor itself or by the underlying
cirrhosis. Any prognostic prediction should also take into account the
potential impact of therapeutic interventions. Only surgical resection,
liver transplantation and percutaneous ablation achieve a relatively
high rate of complete responses in patients with tumors diagnosed at an
early stage and may improve survival. By contrast, patients diagnosed at
an advanced stage will receive palliative treatment with unproven
survival benefits. Each stage and each treatment have their specific
prognostic predictors. Thus, the most accurate prognostic system will
have to use a specific model for each strata at which patients may be
diagnosed: early, intermediate-advanced and terminal. Patients at an
early stage may achieve a 5-year survival rate above 50%, those at
intermediate-advanced present a 20-50% survival at 3 years and those at
terminal stage die within six months. In addition to predicting
prognosis, the staging system should also guide the selection of
treatment and this is the major advantage of the classification applied
in the Barcelona-Clinic Liver Cancer Group.
20
UI - 11941988
AU - Higashihara H; Okazaki M
TI -
Transcatheter arterial chemoembolization of hepatocellular carcinoma: a
Japanese experience.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):72-8
AD - Department of Radiology, Fukuoka University Hospital, 7-45-1, Nanakuma,
Jonan-ku, Fukuoka, 814-0180, Japan. hi-hgshr@fukuoka-u.ac.jp
Hepatocellular carcinoma is one of the most common causes of cancer
death in Japan and in 80% of cases is associated with chronic liver
disease caused by hepatitis C virus. Poor hepatic function reserve due
to underlying cirrhosis is the primary factor which limits extended
surgical resection in many cases. Furthermore, in patients treated by
curative resection, high incidence of recurrent tumors or/and newly
developed tumor in the residual liver was reported. Therefore, the aim
of various therapeutic options such as operation, percutaneous ethanol
injection, radiofrequency coagulation therapy and transcatheter arterial
chemoembolization should be the local control of hepatocellular
carcinoma. Transcatheter hepatic arterial chemoembolization has a main
role for the multidisciplinary treatment for hepatocellular carcinoma
with this biological behavior.
21
UI - 11941989
AU - Carr BI
TI -
Hepatic artery chemoembolization for advanced stage HCC: experience of
650 patients.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):79-86
AD - Liver Cancer Center, Thomas E. Starzl Transplant Institute, University
of Pittsburgh, Pittsburgh, PA 15213, USA. carrbi@msx.upmc.edu
Hepatic artery chemotherapy using cisplatin in various protocols was
examined in 650 patients. Overall objective tumor response rate (PR) was
65%. Average survival was 7.5 mo in patients with tumor progression,
18.0 mo for tumor stability and 32.0 mo for PR. 1- and 2-yr survival was
70% and 40% in responders, 20% and 0% in progressors. Prognostic factors
were examined in 155 patients treated with cisplatin and gelfoam
chemo-occlusion. In survival groups of > 24 mo, 4-24 mo and < 4 mo,
similar numbers had cirrhosis, hepatitis B virus, hepatitis C virus and
alcoholism. Decreased survival was associated with abnormal bilirubin,
albumin and prothrombin time. Tumor vascularity and response to
chemotherapy were associated with prolonged survival. Tumor vascularity
seemed important for tumor response. Portal vein thrombosis occurred in
all groups. Lesion number, bilobarity and maximum size had no
correlation with response or survival. We analyzed the cause of death in
425 patients. No evidence of hepatocellular carcinoma progression,
judged by absence of change in CT scan or tumor marker in the last 4
months of life, was found in 42%. A group of 57 patients were treated
with cisplatin in dose range 125-200 mg/m2 alone or with gelfoam. In
both groups, responders survived longer than non-responders: cisplatin
alone responder mean survival, 29.0 mo, non-responder 11.1 mo, P <
0.0001. There was a strong effect of dose density on median survival for
cisplatin alone, but not for cisplatin and gelfoam. CONCLUSIONS: A large
experience of single-agent cisplatin chemo-occlusion is summarized. Good
liver function and tumor vascularity are associated with response to
chemotherapy, which in turn is associated with enhanced survival. Many
deaths are due to cirrhosis and not hepatocellular carcinoma.
22
UI - 11941990
AU - Takayama T; Makuuchi M
TI -
Prevention of hepatocellular carcinoma recurrence: actuality and
perspectives.
SO - Hepatogastroenterology 2002 Jan-Feb;49(43):87-90
AD - Third Department of Surgery, Nihon University School of Medicine, 30-1
Oyaguchikami-machi, Itabashi-ku, Tokyo 173-8610, Japan.
takayama@med.nihon-u.ac.jp
Postsurgical recurrence of hepatocellular carcinoma is frequent and
fatal. Various adjuvant treatments to possibly prevent recurrence have
been recommended, which seem to depend on expectation rather than
evidence. Up to now, randomized controlled trials have been conducted to
clarify the clinical effect of the 4 therapeutic options including
acyclic retinoid, 131I-lipiodol, adoptive immunotherapy, and interferon.
We have recently demonstrated that adoptive immunotherapy is a safe,
feasible treatment that can reduce the risk of recurrence and improve
recurrence-free outcomes. Actually all the options reduced in part the
recurrence but had drawbacks in the their effectiveness, and large
trials are needed to assess other important endpoints, such as clinical
feasibility, risk-benefit and cost-effectiveness. Recurrence control of
hepatocellular carcinoma is the clinical priority, and we are
approaching this goal.
23
UI - 12161910
AU - Voirin D; Payan Y; Amavizca M; Letoublon C; Troccaz J
TI -
Computer-aided hepatic tumour ablation: requirements and preliminary
results.
SO - C R Biol 2002 Apr;325(4):309-19
AD - Laboratoire TIMC, faculte de medecine, domaine de la Merci, 38706 La
Tronche, France.
Surgical resection of hepatic tumours is not always possible, since it
depends on different factors, among which their location inside the
liver functional segments. Alternative techniques consist in local use
of chemical or physical agents to destroy the tumour. Radio frequency
and cryosurgical ablations are examples of such alternative techniques
that may be performed percutaneously. This requires a precise
localisation of the tumour placement during ablation. Computer-assisted
surgery tools may be used in conjunction with these new ablation
techniques to improve the therapeutic efficiency, whilst they benefit
from minimal invasiveness. This paper introduces the principles of a
system for computer-assisted hepatic tumour ablation and describes
preliminary experiments focusing on data registration evaluation. To
keep close to conventional protocols, we consider registration of
pre-operative CT or MRI data to intra-operative echographic data.
24
UI - 12113666
AU - Ye S
TI -
[Present status and evaluation of interventional therapy for primary
hepatocellular carcinoma]
SO - Zhonghua Gan Zang Bing Za Zhi 2002 Jun;10(3):165-6
AD - Liver Cancer Institute, Fudan University, Shanghai 200032, China.
25
UI - 12113667
AU - Guo W; Yu E; Yi C; Wu W; Lin J
TI -
[Prognostic factors influencing survival in patients with large
hepatocellular carcinoma receiving combined transcatheter arterial
chemoembolization and radiotherapy]
SO - Zhonghua Gan Zang Bing Za Zhi 2002 Jun;10(3):167-9
AD - Oncology Department of Cancer Center, Xinhua Hospital of Shanghai Second
Medical University, Shanghai 200092, China.
OBJECTIVE: To observe the long-term effects of combined transcatheter
arterial chemoembolization (TACE) and radiotherapy for patients with
large hepatocellular carcinoma (HCC) and to analyze the prognostic
factors. METHODS: A total of 107 patients with large unresectable HCC
(the largest diameter of tumor ranged from 5 to 18 cm) were treated with
TACE followed by external-beam irradiation. Acute effects and survival
rates were observed. The Cox proportional hazards model was used to
analyze the prognostic factors. RESULTS: An objective response was
achieved in 48.6% of the cases. The cumulative survival rates at 1, 3,
and 5 years were 59.4%, 28.4%, and 15.8%, respectively. The tumor number
and irradiation dose were the independent prognostic factors. The
cumulative survival rates of the patients with a solitary lesion (75.8%,
43.9%, and 26.8% at 1, 3, and 5 years, respectively) were significantly
higher than those with multiple lesions (31.3%, and 5.0% at 1 and 3
years, respectively, P=0.0005). The survival rates of the patients
received irradiation above 40 Gy (95.8%, 74.7%, and 37.4% at 1, 3, and 5
years, respectively) were significantly higher than those received 20~40
Gy (60.9%, 20.7%, and 10.3%, respectively) and those received radiation
lower than 20 Gy (26.7%, 7.1%, and 7.1%, respectively, P=0.0001).
CONCLUSIONS: Combined TACE with radiotherapy is a promising treatment
for large unresectable HCC. The number of tumor is the most important
clinical prognostic factor. Delivering the highest irradiation dose
within the tolerance of the liver is the key to improve the long-term
effect.
26
UI - 12113669
AU - Li C; Xu D; Xu D; Li X; Zhang W; Liu Y
TI -
[Hyperthermal lipiodol embolization and thermocoagulation for the
treatment of primary hepatocellular carcinoma]
SO - Zhonghua Gan Zang Bing Za Zhi 2002 Jun;10(3):174-6
AD - Ditan Hospital, Beijing 100011, China.
OBJECTIVE: To explore the efficacy of hyperthermal lipiodol embolization
and thermocoagulation for the treatment of primary hepatocellular
carcinoma. METHODS: One hundred and thirty-one cases were randomized
into two groups: the hyperthermal dilute lipiodol embolization group (63
cases) and the chemoembolization group (68 cases). With Seldinger's
method, We first placed the catheter to the targeting vessel
superselectively and then put the hyperthermal dilute lipiodol (110
degrees C) 10~30ml to the tumor vessels to IV degree for the former
group; gave the lipiodol-epirubicin emulsion by the same way to the
latter group. RESULTS: The rate of tumor minification and AFP
normalization in the hyperthermal lipiodol embolization group was higher
than that in the lipiodol-epirubicin embolization group. The side
effects and the liver damage were mild in the former group. The survival
time of the patients in the former group was longer than that in the
latter group. CONCLUSIONS: Embolization of the tumor vessels with
hyperthermal dilute lipiodol is more thorough due to its better
fluidity. The thermocoagulation of the hyperthermal dilute lipiodol
becomes stronger for its higher specific heat. It is therefore a good
technique for the treatment of primary hepatocellular carcinoma.
27
UI - 12202976
AU - Rossi S; Garbagnati F; Rosa L; Azzaretti A; Belloni G; Quaretti P
TI -
Radiofrequency thermal ablation for treatment of hepatocellular
carcinoma.
SO - Int J Clin Oncol 2002 Aug;7(4):225-35
AD - Operative Unit for Liver Cancer Diseases, Policlinico S. Matteo IRCCS,
Piaz.le Golgi no.1, 27100, Pavia, Italy. s.rossi@smatteo.pv.it
28
UI - 12071454
AU - Rindani RB; Hugh TJ; Roche J; Roach PJ; Smith RC
TI -
131I lipiodol therapy for unresectable hepatocellular carcinoma.
SO - ANZ J Surg 2002 Mar;72(3):210-4
AD - Department of Surgery, The University of Sydney, Royal North Shore
Hospital, St Leonards, New South Wales, Australia.
BACKGROUND: More than 80% of hepatocellular carcinoma tumours (HCC) are
unresectable at presentation because of the multicentric nature of the
disease or the severity of liver disease. Arterially administered
lipiodol is preferentially retained by HCC and has been used as a
vehicle for delivery of therapeutic agents to the tumour. The aim of
this phase I study is to present the experience with 131I-labelled
lipiodol in the treatment of unresectable HCC. METHODS: 131Iodine
lipiodol treatment was administered to 12 patients with unresectable HCC
between 1994 and 1999. The outcome of treatment in these patients was
evaluated for survival, clinical tolerance, liver function tests,
alpha-fetoprotein (AFP) levels and changes in tumour size on computed
tomography (CT) scans. RESULTS: Ten of the 12 patients received more
than one 131I treatment. Five patients had treatment for post-resection
recurrence. Serum AFP levels dropped initially in five of the seven
patients with elevated values. Tumour size, evaluated by CT scans at 3
months, decreased in six patients and remained stable in the rest,
except one patient in whom both the AFP level and tumour size had
increased. Using life table analysis, the 50% survival was 19 months.
CONCLUSIONS: Intra-arterial 131I treatment was very well tolerated. A
reduction in AFP levels and tumour size occurred in half of the patients
and resulted in a 50% probability of survival of 19 months. Further
examination of the value of this treatment in phase II and III studies
is required.
29
UI - 12228902
AU - Perilongo G; Dall'Igna P; Sainati L
TI -
Modern treatment of childhood hepatoblastoma: what do clinicians and
pathologists have to say to each other?
SO - Med Pediatr Oncol 2002 Nov;39(5):474-7
AD - Division of Haematology-Oncology, Department of Paediatrics,
University-Hospital of Padova, Padova, Italy. giorgio.perilongo@unipd.it
30
UI - 12228904
AU - Finegold MJ
TI -
Chemotherapy for suspected hepatoblastoma without efforts at surgical
resection is a bad practice.
SO - Med Pediatr Oncol 2002 Nov;39(5):484-6
AD - Department of Pathology, Texas Children's Hospital, Houston, Texas
77030, USA. finegold@bcm.tmc.edu
BACKGROUND: US and European practices differ with respect to treating
hepatoblastoma (HB). Should chemotherapy be given prior to resection in
all cases, and even without biopsy confirmation (SIOPEL)? PROCEDURE AND
RESULTS: US data indicate that 40% of HBs are primarily resectable with
no operative mortality and that those with pure fetal histology and low
mitotic rate do not require toxic chemotherapy. They also suggest that
those with a significant fraction of small undifferentiated cells do not
respond to otherwise effective chemotherapy. Both US and European
studies report a significant error rate in the clinical and imaging
diagnosis of HB. CONCLUSIONS: Although only 6.5% of confirmed HBs fall
into categories that would be managed differently by US standards, there
is no justification for denying those patients a more appropriate
treatment nor should the 6-10% of cases that are misdiagnosed as HB be
treated incorrectly. Copyright 2002 Wiley-Liss, Inc.
31
UI - 11783240
AU - Liu C; Cai Y; Huang Z
TI -
[Clinical study on effect of Chinese herbal medicine on liver damage
caused by hepatic artery chemoembolization]
SO - Zhongguo Zhong Xi Yi Jie He Za Zhi 1999 May;19(5):276-8
AD - Zhaoqing Municipal Hospital of TCM, Guangdong (526020).
OBJECTIVE: To observe the effect of Chinese herbal medicine on hepatic
artery chemoembolization caused liver damage. METHODS: One hundred and
ten patients, who received hepatic artery chemoembolization, were
divided into two groups, 60 patients in the treated group were treated
with Qinggan Jiedu Sanjie Decoction and the other 50 Patients in the
control group treated with routine western medicine. The changes of
liver function, cirrhosis incidence and exacerbation rate of both groups
were observed. RESULTS: The total liver function deterioration rate of
the treated group, according to Child's grading standard, was 46.67%,
while that of the control group was 68.00%, the former was much lower
than the latter (P < 0.05). The cirrhosis incidence and exacerbation
rate in the treated group were 35.00% (7/20) and 50.00% (20/40)
respectively, while in the control group, they were 65.00% (13/20) and
76.67% (23/30) respectively. The difference between the two groups was
also significant (P < 0.05). CONCLUSION: Qinggan Jiedu Sanjie Decoction
has some effect on alleviating and preventing hepatic damage caused by
hepatic artery chemoembolization.
32
UI - 12354601
AU - Kamada K; Kitamoto M; Aikata H; Kawakami Y; Kono H; Imamura M; Nakanishi
TI -
T; Chayama K
Combination of transcatheter arterial chemoembolization using
cisplatin-lipiodol suspension and percutaneous ethanol injection for
treatment of advanced small hepatocellular carcinoma.
SO - Am J Surg 2002 Sep;184(3):284-90
AD - First Department of Internal Medicine, Hiroshima University School of
Medicine, 1-2-3 Kasumi, Minami-ku, 734-8551, Hiroshima City, Hiroshima,
Japan. kkamada@hiroshima-u.ac.jp
BACKGROUND: We evaluated the long-term efficacy of the combination of
transcatheter arterial chemoembolization (TACE) using cisplatin-lipiodol
suspension and percutaneous ethanol injection (PEI) for treatment of
advanced small hepatocellular carcinoma (HCC). PATIENTS AND METHODS:
Sixty-nine patients with HCC less than 3 cm in diameter and at most
three lesions were enrolled in this study. HCC nodules were confirmed to
be hypervascular by angiography. Thirty-two patients were treated with a
combination of TACE and PEI (TACE/PEI group) and 37 patients with TACE
alone (TACE group). RESULTS: The 5-year survival rates were 50% for the
TACE/PEI group and 22% for the TACE group. The TACE/PEI group had a
slightly but not significantly better survival than the TACE group. The
5-year survival rates of patients with solitary HCC were 61% for the
TACE/PEI group and 24% for the TACE group. Although the two therapeutic
groups both had high rates of recurrence, the rates in the TACE/PEI
group were significantly lower than those in the TACE group (P <0.05).
Severe complications such as intraperitoneal bleeding and segmental
hepatic infarction were observed at low incidence, and recovered with
supportive treatment. CONCLUSIONS: The combination of TACE and PEI
appears to prolong survival, compared with TACE alone. This combination
therapy can thus be a valuable form of treatment for unresectable
advanced small HCC.
33
UI - 12352881
AU - Srinivasan P; McCall J; Pritchard J; Dhawan A; Baker A; Vergani GM;
TI -
Muiesan P; Rela M; David Heaton N
Orthotopic liver transplantation for unresectable hepatoblastoma.
SO - Transplantation 2002 Sep 15;74(5):652-5
AD - Liver Transplant Surgical Service, Institute of Liver Studies, London,
UK.
BACKGROUND: The outcome of treatment for advanced hepatoblastoma has
recently improved after the introduction of preoperative or pre- and
postoperative cisplatin-containing chemotherapy combined with complete
surgical excision. The role of liver transplantation in a population of
patients who have received this regimen has not been clearly defined.
METHODS: Orthotopic liver transplantation (OLT) was performed in 13
children, aged 5 months to 11 years (median 27 months), who were
assessed with unresectable hepatoblastoma, and whose pretreatment
extent-of-disease was based on radiologic findings
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