ABSTRACT
OBJECTIVE: To evaluate the clinical efficiency and feasibility for the treatment of recurrent hepatocellularcarcinoma treated by percutaneous microwave ablation assisted by three-dimensional visualization.METHODS: Theclinical data of 84 consecutive patients with recurrent hepatocellular carcinoma treated by percutaneous microwaveablation in Department of Interventional Ultrasonography,Chinese PLA General Hospital from December 1, 2017 to June1, 2019 were analyzed retrospectively. The patients were divided into three-dimensional reconstruction group(30 patients,49 tumors)and normal group(54 patients,111 tumors)according to whether evaluated by three-dimensionalvisualization. Treatment related indicators and the prognosis were compared. Preoperative total liver volume,tumorvolume,planning ablation volume,postoperative total liver volume and ablation volume were computed via three-dimensional visualization system in three-dimensional reconstruction group. Furthermore,the preoperative planningablation volume and actual postoperative ablation volume were compared between the two group.RESULTS: All patientsaccomplished the procedure of percutaneous microwave ablation. The maximal diameter of tumor was(4.3±1.0)cm,andthe follow-up period was 10(2-19) months. The three-dimensional reconstruction group and normal group had nosignificant differences in major complications rate(6.7% vs. 9.3%), overall survival rate(100% vs. 94.4%), intrahepaticdistant recurrence rate(8.2% vs. 12.6%) and local tumor progression rate(6.1% vs. 10.8%)(P>0.05). There was nostatistically significant difference between preoperative planning ablation volume and postoperative ablation volume inthe two groups(P=0.616). The ratio of residual liver volume/standard liver volume was(98.0±25.6)%. Alanine aminotransferase,aspartate amino transferase,total bilirubin and cholinesterase had no statistically significant difference before and after ablation between two groups(P>0.05).CONCLUSION: The role of ultrasound-guidedpercutaneous microwave ablation assisted by three-dimensional visualization for the accurate treatment of recurrent hepatocellular carcinoma is of great importance.
ABSTRACT
OBJECTIVE: To observe the safety and efficacy of rehepatectomy and radiofrequency ablation for patientswith recurrent hepatocellular carcinoma(HCC).METHODS: A consecutive sample of 159 recurrent HCC patients whounderwent rehepatectomy(n=77) or radiofrequency ablation(n=82) from January 2005 to December 2014 were analyzedretrospectively. Propensity score analysis was used. The Kaplan-Meier method was used for survival analysis.RESULTS: Propensity score analysis chose 41 pair patients. Patients in the radiofrequency ablation group were with lower rate ofperioperative mortality and morbidiy,shorter length of hospital stay. When calculate the survival time from the date ofrehepatectomy or radiofrequency ablation,or calculate the survival time from the date of the first hepatectomy,the twoarms showed similar overall survival(P=0.258,0.820). Moreover,overall survival were similar after propensity scoreanalysis(P=0.443,0.917).CONCLUSION: Radiofrequency ablation was safety,associated with shorter length of hospitalstay and similar long-term overall survival with rehepatectomy for recurrent HCC.
ABSTRACT
OBJECTIVE: To investigate the application value of fusion indocyanine green fluorescence imaging(FIGFI)in the surgical treatment of recurrent hepatocellular carcinoma.METHODS: From January 2015 to January 2018,theclinical data of 12 patients with recurrent hepatocellular carcinoma who received surgical treatment guided by three-dimensional visualization technology combined with FIGFI at Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University were analyzed. High-quality thin-slice CT data were collected for three-dimensionalvisualization and reconstruction,individualized liver segmentation and preoperative surgical planning. FIGFI was used todefine the demarcation of tumors,to determine the extent of hepatectomy,and to detect small hepatocellular carcinomaand metastases during the operation. The use of FIGFI in combination with three-dimensional visualization imagesguided the precision hepatectomy. postoperative efficacy was observed by follow-up.RESULTS: All the 12 patientsunderwent successful three-dimensional reconstruction and liver resection. Preoperative CT revealed 12 lesions(80%);intraoperative FIGFI detected 15 lesions(100%);of the three newly discovered lesions,2 were hepatocellular carcinomaand 1 was cirrhosis nodule. The operation time was 267.5(183,345)minutes and the amount of bleeding was 287.5(62.5,513.5)m L. No severe complications such as abdominal hemorrhage,abdominal infection,bile leakage and liverfailure occurred postoperatively. No death occurred during the perioperative period. The median follow-up period was 29 (3-36)months; during the follow-up period, 1 casewas lost and 4 cases had metastasis or recurrence.All the patients were alive at the end of the follow-up.CONCLUSION: FIGFI is helpful to achieveanatomical, functional and radical hepatectomy inthe treatment of recurrent hepatocellular carcinoma.
ABSTRACT
The recurrence rate of primary hepatocellularcarcinoma is very high,and repetitive resection is still the besttreatment for operable recurrent hepatocellular carcinoma.Indocyanine green(ICG) has been widely used andpopularized in resection of hepatocellular carcinoma,providesmore possibilities and diversity for the surgical treatment ofrecurrent hepatocellular carcinoma. Combined withpreoperative imaging,three-dimensional imaging technologyand intraoperative ultrasound,ICG can effectively improve theradical and accuracy of the operation for recurrent hepatocellular carcinoma. ICG-guided hepatectomy isappropriate for the new concept and technical system of liversurgery advocated by modern medical model, and realizesfunctional and anatomical hepatectomy for recurrenthepatocellular carcinoma.
ABSTRACT
The low resectability rate of recurrent hepatocellular carcinoma,abdominal adhesion and anatomical variation caused by the original hepatectomy increase the difficulty and risk of liver re-resection,which hampers the development of minimally invasive management of posthepatectomy hepatocellular carcinoma recurrence. In recent years,with the update of laparoscopic equipment and the accumulation of surgeon experience, preliminary exploration of laparoscopic liver re-resection for patients with posthepatectomy hepatocellular carcinoma recurrence has begun. In patients with strict indications,laparoscopic reresection can significantly reduce the incidence of perioperative complications and achieve similar survival results as the open surgery. However,as the treatment is still in the exploratory stage,it is recommended to perform only under the strict case selection of medical centers with rich experience in open and laparoscopic liver resection. High quality clinical research is still needed to promote its standardization.
ABSTRACT
Recurrent hepatocellular carcinoma(HCC) is acommon problem in the treatment of HCC patients. At present,there is a lack of staging and treatment system for recurrenthepatocellular carcinoma,and a lack of high-level clinicalresearch. Therefore,there is much controversy in the treatmentof recurrent hepatocellular carcinoma. The controversy ismainly focused on whether it is proper to take aggressivelyrepeated surgical resection or liver transplantation. For recurrent tumors of polyclonal origin,clinical treatmentdecisions are basically based on the staging and treatmentsystem of primary hepatocellular carcinoma,and the prognosisis not inferior to that of primary tumors. For recurrent tumorsof monoclonal origin,it tends to be less invasive,such asinterventional,ablation,radiotherapy or targeted drugs. Thetreatment strategy for hepatocellular carcinoma must considermany factors, such as trauma,safety,effectiveness and cost. Itis similar to and still a little different from that of primaryhepatocellular carcinoma. Therefore,the treatment of recurrenthepatocellular carcinoma cannot fully refer to the treatmentsystem of primary hepatocellular carcinoma.
ABSTRACT
High recurrence rate and metastasis rate after primary surgery for hepatocellular carcinoma have been restricting the long-term survival of patients. For the treatment of recurrent hepatocellular carcinoma, comprehensive treatment based on surgery is the main strategy. For patients who are unsuitable for surgery,local ablation,TACE,radiotherapy, systemic chemotherapy, targeted therapy,immunotherapy,traditional Chinese medicine and optimal supportive therapy are effective measures,which can delay disease progression and improve patient survival. According to the patient's characteristics and individual differences,the multidisciplinary treatment model should be adopted to optimize the treatment effect and reduce side effects,which will benefit the patients with better medical experience and longer overall survival rate.
ABSTRACT
OBJECTIVE: To investigate the effect of clinicopathological factors on the recurrent hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT)after radical resection.METHODS: The data of patients with HCC who underwent radical resection between January 2000 and December 2014 in Affiliated Hospital of Qingdao University were analyzed retrospectively.Clinical and pathological data from first resection to the recurrence of HCC with PVTT were extracted in the form of data tables.All patients were divided into PVTT group and non PVTT group according to the occurence of PVTT at time of HCC recurrence,and the risk factors of PVTT formation were analyzed.Risk factors influencing the formation time,from radical resection to HCC recurrence,were analyzed in recurrent HCC patients with PVTT.RESULTS: Univariate analysis results showed that patients having HCC with multiple tumors,no tumor capsule,and Child-pugh B grade had a high proportion of PVTT when HCC recurred.The results of logistic regression analysis showed that multiple tumors,no tumor capsule,and Childpugh B grade were independent risk factors for PVTT formation after radical resection of HCCA predictive model was established on the basis of the three risk factors(1 point for each factor).ROC curve showed the total model score has certain predictive value.The area under the curve was 0.662(P=0.003,95% CI:0.557-0.766),cut-off value was 0.5 points,Youden index was 0.302(sensitivity=60.0%,specificity=70.2%).The higher the model score,the shorter the tumor-free survival time(P=0.007),and the higher the incidence of PVTT recurrence(P=0.001).The results of Kaplan-Meier(log-rank test)and multivariate analysis of Cox regression model showed that lower differentiation of HCC was an independent risk factor influencing the time from radical resection to HCC recurrence with PVTT(P=0.000). CONCLUSION: Patients with multiple tumor foci,no tumor capsule and Child grade B grade liver cancer are more likely to recur with PVTT after RO operation.And among them,the low differentiation of liver cancer grows faster.A closer follow-up or preventive treatment of patients with high-risk factors may improve prognosis.
ABSTRACT
Hepatectomy is one of the curative therapies for hepatocellular carcinoma (HCC). However, the 5-year recurrence rate after resection is higher as 70%, and the 5-year survival rate is less than 50%. Furthermore, there is no consensus about the treatment strategy for recurrent HCC after hepatectomy. To our knowledge, radiofrequency ablation (RFA) has been widely applied, either with curative or palliative intention. And it is a feasible treatment for recurrent HCC because of majority of the recurrent HCCs with diameter less than 3 cm. The therapeutic efficacy after RFA is similar to re-resection with several advantages, such as minimal invasion, less complications and short hospitalization duration. This study discusses the feasibility of RFA which is used to treat recurrent small HCC, aiming at providing information for promoting the treatment efficacy of recurrent small HCC.
ABSTRACT
OBJECTIVE: To investigate the additional diagnostic value of color mapping of the hepatic arterial enhancement fraction (AEF) for detecting recurrent or residual hepatocellular carcinoma (HCC) in patients treated with transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: Seventy-six patients with 126 HCCs, all of whom had undergone previous TACE, and subsequently, underwent follow-up multiphasic liver CT scans, were included in this study. Quantitative color maps of the AEF of the whole liver were created, by using prototype software with non-rigid registration. The AEF was defined as the ratio of the attenuation increment during the arterial phase to the attenuation increment during the portal phase. Two radiologists independently analyzed the two image sets at a two-week interval, i.e., the multiphasic CT image set and the second image set of the AEF color maps and the CT images. The additional diagnostic value of the AEF color mapping was determined, by the use of the jackknife-alternative free-response receiver-operating-characteristic analysis. The sensitivity and positive predictive values for detecting HCCs of each image set were also evaluated and compared. RESULTS: The reader-averaged figures of merit were 0.699 on the initial interpretation of the MDCT image set, and 0.831 on the second interpretation of the combined image set; the difference between the two interpretations was significant (p value < 0.001). The mean sensitivity for residual or recurrent HCC detection increased from 62.7% on the initial analysis to 82.1% on the second analysis using the AEF color maps (p value < 0.001). The mean positive predictive value for HCC detection was 74.5% on the initial analysis using MDCT, and 71.6% on the second analysis using AEF color mapping. CONCLUSION: Quantitative color mapping of the hepatic AEF may have the possibility to increase the diagnostic performance of MDCT for the detection of recurrent or residual HCC without the potential risk of radiation-related hazards.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Carcinoma, Hepatocellular/pathology , Chemoembolization, Therapeutic , Liver Cirrhosis/complications , Liver Neoplasms/pathology , Neoplasm Recurrence, Local/pathology , Predictive Value of Tests , ROC Curve , Radiographic Image Interpretation, Computer-Assisted , Retrospective Studies , Sensitivity and Specificity , Software , Tomography, X-Ray ComputedABSTRACT
Bile-duct invasion is rare in patients with hepatocellular carcinoma (HCC). We report a case that received peroral direct cholangioscopy (PDCS)-guided endoscopic biopsy and photodynamic treatment (PDT) for recurrent HCC with intraductal tiny nodular tumor growth. A 64-year-old woman presented with recurrent right upper-quadrant pain. Six months previously she had been diagnosed with HCC with bile-duct invasion in the right anterior segment and had received right anterior segmentectomy. On pathological examination, the margin of resection was clear, but macroscopic bile-duct invasion was noted. On admission, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) revealed a 0.5-cm-sized polypoid mass at the hilar portion. ERCP-guided biopsy failed, and an ampullary stricture was noted. PDCS-guided endoscopic biopsy was thus performed, and histopathology of the retrieved specimen revealed HCC. The patient submitted to PDT. There was no procedure-related complication. After 1 month of PDT the polypoid lesion and scar change at the hilar lesion had disappeared.
Subject(s)
Female , Humans , Middle Aged , Biopsy , Carcinoma, Hepatocellular , Cholangiopancreatography, Endoscopic Retrograde , Cholangiopancreatography, Magnetic Resonance , Cicatrix , Constriction, Pathologic , Endoscopes , Mastectomy, Segmental , Photochemotherapy , TriazenesABSTRACT
PURPOSE: The effective treatment of an intrahepatic recurrent hepatocellular carcinoma (HCC) after a curative resection is very important in improving the prognosis after resection of HCC. The purposes of this study were to evaluate the clinicopathological characteristics and clarify the outcome of the patients after a repeat hepatectomy for a recurrent HCC. METHODS: Between March 1991 and February 2004, 16 patients underwent repeat hepatectomy for a recurrent HCC at the Yeungnam university hospital. The clinicopathological and follow-up data were retrospectively analyzed. RESULTS: There was no significant difference in the average of ICG R15 between the primary (11.2+/-1.8%) and repeat hepatectomy (18.2+/-2.8%). There were a higher proportion of minor (Couinaud's segment < or =2) resection in the repeat (93.8%) than the primary hepatectomy groups (75.0%), but the difference was not statistically significant. A significant difference was seen in the tumor size between the primary (3.6+/-0.5 cm) and repeat hepatectomy groups (2.9+/-1.9 cm). The average number of tumor in both the primary and repeat hepatectomy was equal (1.3+/-0.6). The number of cases of multicentric occurrence of HCC (12 cases) was more than that of intrahepatic metastasis of HCC (4 cases). The mean interval between the primary and repeat hepatectomy was 48.0+/-33.0 months (13~136 months). The average survival time after a primary hepatectomy was 83.6+/-36.3 months. The cumulative 1, 3, 5, and 7 year survival rates were 100, 100, 85.9, and 75.3% after a primary hepatectomy and 90, 56.5, 56.5 and 56.5% after a repeat hepatectomy, respectively. CONCLUSION: A repeat hepatectomy leads to a satisfactory outcomes in selected HCC patients.