Hepatic Resection Provides Survival Benefit for Selected Intermediate-Stage (BCLC-B) Hepatocellular Carcinoma Patients.

PURPOSE: The intermediate stage of hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer [BCLC] B) comprises a highly heterogeneous population, and the treatment strategy is still controversial. Because of the heterogeneity, a subclassification of intermediate-stage HCCs was put forward by Bolondi according to the 'beyond Milan and within up-to-7' criteria and Child-Pugh score. In this study, we aim to analyze the prognosis of BCLC-B stage HCC patients who received hepatic resection according to the Bolondi's subclassification. MATERIALS AND METHODS: One thousand and one hundred three patients diagnosedwith HCC and treatedwith hepatic resectionwere enrolled in our hospital between 2006 and 2012. According to Bolondi's subclassification, the BCLC-B patients were divided into four groups. Recurrence-free survival (RFS) and overall survival (OS) were analyzed. RESULTS: According to Bolondi's subclassification, the BCLC-B patients were divided into four groups: B1 (n=41, 18.7%), B2 (n=160, 73.1%), B3 (n=11, 5.0%), and B4 (n=7, 3.2%). Significant difference was observed between B1 and other groups (B1 vs. B2, p=0.022; B1 vs. B3, p < 0.001; B1 vs. B4, p < 0.001), but no difference for B2 vs. B4 (p=0.542) and B3 vs. B4 (p=0.542). In addition, no significant differences were observed between BCLC-A and BCLC-B1 group for both RFS (p=0.087) and OS (p=0.643). In multivariate analysis, BCLC-B subclassification was not a risk factor for both OS (p=0.263) and RFS (p=0.892). CONCLUSION: In our study, HCC patients at B1 stagewere benefited from hepatic resection and had similar survival to BCLC-A stage patients. Our study provided rationality of hepatic resection for selected BCLC-B stage HCC patients instead of routine transarterial chemoembolization.

Removal of hepatocellular carcinoma extending into the right atrium with extracorporeal circulation.

Hepatocellular carcinoma with tumor thrombus extending into the right atrium is rare and has an extremely poor prognosis. Surgery was once regarded as a contraindication, then as a palliative method to prevent emergencies such as pulmonary embolism or heart failure. With advances of imaging techniques, hepatectomy and widespread use of extracorporeal circulation, conventional viewpoint has gradually changed. For patients with adequate hepatic function reserve and no distant metastases, surgery is recommended. During the past four years, we experienced two such patients, for both of whom we simultaneously resected the hepatic tumor and tumor thrombus in the right atrium under cardiopulmonary circulation and total hepatic blood exclusion. Both of the patients survived the surgery. During the follow-up, one patient died 6 months later due to multiple lung metastases and tumor progression. The other patient experienced recurrence 4 months after surgery and underwent adjuvant treatment modalities including chemotherapy, radiofrequency ablation and transcatheter arterial chemoembolization. Thirty-eight months later, the patient died of multiple metastasis and hepatic failure.