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HCC in patients with cirrhosis. Tanaka and colleagues [108] reported several benefits of PVE in a larger study of patients with HCC and cirrhosis. In addition, patients with recurrence fol- lowing PVE plus resection were more often candidates for further treatments such as chemoembolization, an additional benefit of PVE in the long term (Table . Another study validated residual volume...
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Laparoscopic Liver Resection for HCC:. Keywords Laparoscopic liver resection · HCC · Hepatic resection. >90% of the cases on an underlying hepatic disease [1]. Screening programs allow diagnosis at an early stage where curative treatments can be proposed. In recent years liver resection in cirrhotic patients became safer [4, 5] and achieved a key role in HCC treatment: in advanced...
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Considering the 69 patients affected by HCC morbidity rate was 21.7%, but it significantly decreased in the second half of our series (lower than 10%) [25].. Two complications are commonly feared in laparoscopic liver surgery: gas embolism and bleeding. In the literature some severe hemorrhagic complications have been reported, mainly related to hepatic veins injuries . In the published series,...
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12 Laparoscopic Liver Resection for HCC 205 47. Torzilli G, Donadon M, Marconi M et al (2008) Hepatectomy for stage B and stage C hepato- cellular carcinoma in the Barcelona Clinic Liver Cancer classification: results of a prospective analysis. Abdel-Atty MY, Farges O, Jagot P, Belghiti J (1999) Laparoscopy extends the indications for liver resection in patients with cirrhosis. Jiao...
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13 Laparoscopic Liver Surgery for the Management of Hepatocellular Carcinoma 215 in itself often obviates major hemorrhage. Lastly, use of endovascular staplers are used when the remaining vascular pedicle of the tumor is identified when greater than 90% of the tumor is resected. However, depending on the loca- tion of the lesion (e.g., when tumor abuts major vessels), a smaller...
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Traditionally, there have been few effective systemic chemotherapy options for patients with HCC, regardless of stage [58, 59]. More recently, the oral multi- kinase inhibitor of the vascular endothelial growth factor receptor, sorafenib, was shown to have a small but measurable survival benefit in patients with Stage IV HCC [60, 61]. Some patients with unsuspected advanced pathologic stage HCC have...
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14 Liver Transplant for Hepatocellular Carcinoma 235 51. Lu DS, Yu NC, Raman SS et al (2005) Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation. Lu DS, Yu NC, Raman SS et al (2005) Radiofrequency ablation of hepatocellular carcinoma:. treatment success as defined by histologic examination of the explanted liver. Mazzaferro V, Battiston C, Perrone S...
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15.2 (a) Hepatocellular carcinoma (HCC) extending from the posterior branch of the right portal vein into the main right portal vein and into the main portal vein. MHV = middle hepatic vein. Hepatic Vein and IVC Involvement. Similar to their effects on hilar vessels, large HCC lesions involving the hepatic veins or retrohepatic vena cava by external compression rarely invade...
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An even smaller subset of patients with tumors involving major vasculature may be considered for resections utilizing cold preservations techniques. Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Tsai TJ, Chau GY, Lui WY, Tsay SH, King KL, Loong CC, Hsia CY, Wu CW (2000) Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma. Sugino...
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Identifying a local recurrence following RFA can be problematic. Other small studies in patients with metastatic hepatic tumors have supported the role of PET scans in surveillance post-RFA [14–16].. Indications for RFA of Hepatocellular Carcinoma. Therefore, patients with preoperative or intra-operative evidence of extra-hepatic disease should not be considered for RFA.. With a median follow-up of 19 months, only four...
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Microwave Ablation and Hepatocellular Carcinoma. Keywords Microwave ablation · Hepatocellular cancer. Hepatocellular carcinoma remains one of the most common malignant neoplasms and is responsible for greater than one million deaths per year [1]. Prognosis of HCC is exceedingly poor because of the high malignancy biology, high recurrence, and overall resistance to current therapies [2]. The reasons for this are the...
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Kuang M, Lu MD, Xie XY et al (2007) Liver cancer: increased microwave delivery to ablation zone with cooled-shaft antenna–experimental and clinical studies. Izumi N, Asahina Y, Noguchi O et al (2001) Risk factors for distant recurrence of hepato-. cellular carcinoma in the liver after complete coagulation by microwave or radiofrequency ablation. Yamanaka N, Tanaka T, Oriyama T et al...
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The excitement generated by the release of the SHARP trial results (systemic chemotherapy with Sorafenib) overshadowed reality. The initial enthusiasm, more than anything else, highlights the historical absence of measurable progress in the treatment of HCC among the medical oncology community. Therefore, and despite these modest advances in the treatment of HCC, TACE will likely remain the most important treatment...
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19.4 Response. The European Association for the Study of the Liver (EASL) Criteria measures local tumor response based on tumor progression with respect to change in necrosis.. Since extensive tumor necrosis may not be paralleled by a reduction in the diameter of the tumor, in 2000, the EASL recommended a modification to the WHO crite- ria for use in HCC....
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19 Chemoembolization with Drug-Eluting Beads 315 radiofrequency ablation failures. DEB-TACE has the potential to become an effective alternate therapy or palliative measure in the treatment of hepatic malignancy, but standardization needs to be established in both delivery and data collection in order to clarify efficacy. It is a safe alternative in the treatment of unresectable hepatic malignancy, but is unproven...
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Once in the hepatic venous side, these particles then travel via the venous circulation of the heart into the pulmonary artery and subsequently embolize in the arteriolar bed. The ratio of the lung to liver deposition corrected for background is expressed as a percentage of the injected activity. The factors that increase the likelihood of lung shunting are the histology...
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However, results from a phase II study of doxorubicin plus bortezomib were disappointing with a response rate of 2.3% and median survival of 5.7 months [68].. A random- ized phase II study has investigated the combination of sorafenib and doxorubicin compared to doxorubicin alone [70]. However, this being a randomized phase II study the aim was to determine whether or...
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The liver’s role in xenobiotic metabolism, i.e., the modification of drugs and toxic foreign compounds, has long served as a putative explanation for inherent drug resistance of hepatocellular carcinoma (HCC). Therefore, it does not come as a surprise that the initial discovery of the multiple-drug resistance gene (MDR) was in liver tissue [1], and hepatocyte cell lines are a natural...
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Lopez PM, Villanueva A, Llovet JM (2006) Systematic review: evidence-based management of hepatocellular carcinoma—an updated analysis of randomized controlled trials. Llovet JM, Bruix J (2009) Testing molecular therapies in hepatocellular carcinoma: the need for randomized Phase II trials. J Clin Oncol 27:833–835. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC et al (2008)...
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of this combination in patients with HCC. Table 23.3 Selected clinical trials of systemic therapy combinations in patients with advanced HCC. et al. Thomas et al.. (PFS 9 mos) Sun et al. Zhu et al.. Louafi et al.. O’Neil et al.. Abou-Alfa et al. Hsu et al.. Shen et al.. Several targeted agents have been recently tested in patients with...