Adjuvant sorafenib after heptectomy for Barcelona Clinic Liver Cancer-stage C hepatocellular carcinoma patients

AIM: To investigate the efficacy and safety of adjuvant sorafenib after curative resection for patients with Barcelona Clinic Liver Cancer(BCLC)-stage C hepatocellular carcinoma(HCC).METHODS: Thirty-four HCC patients, classified as BCLC-stage C, received adjuvant sorafenib for highrisk of tumor recurrence after curative hepatectomy at a tertiary care university hospital. The study group was compared with a case-matched control group of 68 patients who received curative hepatectomy for HCC during the study period in a 1:2 ratio.RESULTS: The tumor recurrence rate was markedly lower in the sorafenib group(15/34, 44.1%) than in the control group(51/68, 75%, P = 0.002). The median disease-free survival was 12 mo in the study group and 10 mo in the control group. Tumor number more than 3, macrovascular invasion, hilar lymph nodes metastasis, and treatment with sorafenib were significant factors of disease-free survival by univariate analysis. Tumor number more than 3 and treatment with sorafenib were significant risk factors of diseasefree survival by multivariate analysis in the Cox proportional hazards model. The disease-free survival and cumulative overall survival in the study group were significantly better than in the control group(P = 0.034 and 0.016, respectively). CONCLUSION: Our study verifies the potential benefit and safety of adjuvant sorafenib for both decreasing HCC recurrence and extending disease-free and overall survival rates for patients with BCLC-stage C HCC after curative resection.

Value of radiofrequency ablation in the treatment of hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is a malignant disease that substantially affects public health worldwide.It is especially prevalent in east Asia and sub-Saharan Africa,where the main etiology is the endemic status of chronic hepatitis B.Effective treatments with curative intent for early HCC include liver transplantation,liver resection(LR),and radiofrequency ablation(RFA).RFA has become the most widely used local thermal ablation method in recent years because of its technical ease,safety,satisfactory local tumor control,and minimally invasive nature.This technique has also emerged as an important treatment strategy for HCC in recent years.RFA,liver transplantation,and hepatectomy can be complementary to one another in the treatment of HCC,and the outcome benefits have been demonstrated by numerous clinical studies.As a pretransplantation bridge therapy,RFA extends the average waiting time without increasing the risk of dropout or death.In contrast to LR,RFA causes almost no intraabdominal adhesion,thus producing favorable conditions for subsequent liver transplantation.Many studieshave demonstrated mutual interactions between RFA and hepatectomy,effectively expanding the operative indications for patients with HCC and enhancing the efficacy of these approaches.However,treated tumor tissue remains within the body after RFA,and residual tumors or satellite nodules can limit the effectiveness of this treatment.Therefore,future research should focus on this issue.

Radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts

Recent studies have shown that radiofrequency(RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval.

Efficiency and safety of radiofrequency-assisted hepatectomy for hepatocellular carcinoma with cirrhosis:A single-center retrospective cohort study

AIM: To assess the efficiency and safety of radiofrequencyassisted hepatectomy in patients with hepatocellular carcinoma(HCC) and cirrhosis.METHODS: From January 2010 to December 2013, 179 patients with HCC and cirrhosis were recruited for this retrospective study. Of these, 100 patients who received radiofrequency-assisted hepatectomy(RF+ group) were compared to 79 patients who had hepatectomy without ablation(RF- group). The primary endpoint was intraoperative blood loss. The secondary endpoints included liver function, postoperative complications, mortality, and duration of hospital stay.RESULTS: The characteristics of the two groups were closely matched. The Pringle maneuver was not used in the RF+ group. There was significantly less median intraoperative blood loss in the RF+ group(300 vs 400 m L, P = 0.01). On postoperative days(POD) 1 and 5, median alanine aminotransferase was significantly higher in the RF+ group than in the RF- group(POD 1: 348.5 vs 245.5, P = 0.01; POD 5: 112 vs 82.5, P = 0.00), but there was no significant difference between the two groups on POD 3(260 vs 220, P = 0.24). The median AST was significantly higher in the RF+ group on POD 1(446 vs 268, P = 0.00), but there was no significant difference between the two groups on POD 3 and 5(POD 3: 129.5 vs 125, P = 0.65; POD 5: 52.5vs 50, P = 0.10). Overall, the rate of postoperative complications was roughly the same in these two groups(28.0% vs 17.7%, P = 0.11) except that post hepatectomy liver failure was far more common in the RF+ group than in the RF- group(6% vs 0%, P = 0.04).CONCLUSION: Radiofrequency-assisted hepatectomy can reduce intraoperative blood loss during liver resection effectively. However, this method should be used with caution in patients with concomitant cirrhosis because it may cause severe liver damage and liver failure.

Complete response to sorafenib in a patient with recurrent hepatocellular carcinoma

Partial hepatectomy is still the treatment of choice aiming at a cure for patients with hepatocellular carcinoma(HCC), provided that the patient can tolerate the treatment. For patients with multiple recurrent HCC after partial hepatectomy which cannot be treated by re-hepatectomy or local ablative therapy, the prognosis is extremely poor. sorafenib is a molecular-targeted agent which has been demonstrated in two global phase III randomized controlled trials to show survival benefit for advanced HCC. Here, we present a 56-yearold patient with HCC who showed complete clinical response after sorafenib was used for tumor recurrence which developed 3 mo after partial hepatectomy. There was no evidence of progression of disease for 60 mo till now after continuous treatment with sorafenib.

Intrahepatic Glissonian approach and outflow vascular occlusion during partial hepatectomy

Under ultrasound guidance, a blunt suture needle was inserted around the Glissonian pedicle and then sutured. This technique significantly reduced the blood loss and facilitated the procedure of partial hepatectomy. We applied this technique in 182 patients who needed partial hepatectomy. We concluded that this method is simple and easy to occlude the vascular inflow and outflow, and allows an accurate delineation of the anatomic zone and therefore, simplifies the procedure of partial hepatectomy.