Treatment for hepatocellular carcinoma with tumor thrombosis in the hepatic vein or inferior vena cava:A comprehensive review

Hepatocellular carcinoma(HCC)is the most common type of liver cancer with a high mortality rate worldwide.The percentage of HCC patients with vascular invasion is high.However,tumor thrombus in the hepatic vein(HVTT)has a lower incidence than tumor thrombus in the portal vein(PVTT).Conventionally,HCC patients with HVTT are treated the same as HCC patients with PVTT and offered sorafenib or other systemic agents.However,according to recent studies,it is evident that HCC with HVTT shows different outcomes when classified into different subgroups.In this review,we discuss the recent progress and changes in treatment of HCC with HVTT.

Diagnosis and Treatment of Cholangiocarcinoma: A Consensus from Surgical Specialists of China

Cholangiocarcinoma refers to malignant tumors that develop in epithelial lining of biliary system, and it is divided into two categories according to tumor location, intrahepatic cholangiocarcinoma （ICC） and extrahepatic cholangiocarcinoma （ECC）. ICC occurs from the epithelial cells of the intrahepatic bile duct, its branches and interlobular biliary tree; and ECC is divided into hilar cholangiocarcinoma and distal cholangiocarcinoma by the circumscription at the confluence of cystic duct and the common hepatic duct.

Hepatectomy for patients with huge primary liver cancer in Hubei Province of China

Objective: To discuss the safety and feasibility of hep-atectomy for huge primary liver cancer (PLC).Methods: The effect of resection of huge PLC was ex-amined retrospectively. Some problems in resection ofhuge PLC were discussed.Results: Of 375 patients with huge PLC undergoinghepatectomy, 11 (2.9%) died in one month after op-eration. The 1-, 2-, 3-, 5- and 10-year survivalrates of the patients were 63.3%, 45.6%, 34.7%,16.5% and 1.8%, respectively. The effect of prolong-ing survival time was significant.Conclusion: Hepatectomy for huge PLC is safe, feasi-ble, and effective.

Surgery for hepatocellular carcinoma with tumor thrombosis in inferior vena cava: A case report

BACKGROUND Hepatocellular carcinoma(HCC)accompanied by a tumor thrombus is very common.However,the treatment strategy is controversial and varies by the location of the thrombus.CASE SUMMARY We report herein a case of HCC with a tumor thrombus in the suprahepatic inferior vena cava(IVC),which was successfully treated by hepatectomy combined with thrombectomy following sorafenib chemotherapy.A 47-year-old woman with chronic hepatitis was diagnosed with HCC.Computed tomography and magnetic resonance imaging showed that the tumor lesion was located in the right half of the liver,and a tumor thrombus was detected in the suprahepatic IVC near the right atrium.After multi-departmental discussion and patient informed consent,right major hepatectomy and total removal of the tumor thrombus were successfully performed under cardiopulmonary bypass.There were no serious complications after surgery.Following sorafenib treatment,no recurrence has been detected so far(11 mo later).CONCLUSION Surgical treatment followed by adjuvant sorafenib therapy might be an acceptable choice for HCC patients with tumor thrombosis in the IVC.

A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study

Background:Adequate evaluation of degrees of liver cirrhosis is essential in surgical treatment of hepatocellular carcinoma(HCC)patients.The impact of the degrees of cirrhosis on prediction of post-hepatectomy liver failure(PHLF)remains poorly defined.This study aimed to construct and validate a combined pre-and intra-operative nomogram based on the degrees of cirrhosis in predicting PHLF in HCC patients using prospective multi-center’s data.Methods:Consecutive HCC patients who underwent hepatectomy between May 18,2019 and Dec 19,2020 were enrolled at five tertiary hospitals.Preoperative cirrhotic severity scoring(CSS)and intra-operative direct liver stiffness measurement(DSM)were performed to correlate with the Laennec histopathological grading system.The performances of the pre-operative nomogram and combined pre-and intra-operative nomogram in predicting PHLF were compared with conventional predictive models of PHLF.Results:For 327 patients in this study,histopathological studies showed the rates of HCC patients with no,mild,moderate,and severe cirrhosis were 41.9%,29.1%,22.9%,and 6.1%,respectively.Either CSS or DSM was closely correlated with histopathological stages of cirrhosis.Thirty-three(10.1%)patients developed PHLF.The 30-and 90-day mortality rates were 0.9%.Multivariate regression analysis showed four pre-operative variables[HBV-DNA level,ICG-R15,prothrombin time(PT),and CSS],and one intra-operative variable(DSM)to be independent risk factors of PHLF.The pre-operative nomogram was constructed based on these four pre-operative variables together with total bilirubin.The combined pre-and intra-operative nomogram was constructed by adding the intra-operative DSM.The pre-operative nomogram was better than the conventional models in predicting PHLF.The prediction was further improved with the combined pre-and intra-operative nomogram.Conclusions:The combined pre-and intra-operative nomogram further improved prediction of PHLF when compared with the pre-operative nomogram.