1
|
Li DB, Si XY, Wan T, Zhou YM. A pooled analysis of treatment and prognosis of hepatic angiosarcoma in adults. Hepatobiliary Pancreat Dis Int 2018; 17:198-203. [PMID: 29724676 DOI: 10.1016/j.hbpd.2018.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/09/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatic angiosarcoma is a rare malignant vascular tumor presenting unique treatment challenges. The aim of the present study was to determine the treatment and prognosis of this entity. DATA SOURCES A systematic literature search was conducted using PubMed, Embase and Chinese Biomedical Literature database, to identify articles published from January 1980 to July 2017. Search terms were "hepatic angiosarcoma" and "liver angiosarcoma". Additional articles were retrieved through manual search of bibliographies of the relevant articles. Pooled individual data concerning the prognosis following various therapeutic modalities were analyzed. RESULTS A total of 75 articles involving 186 patients were eligible for inclusion. The median overall survival (OS) was 8 months, with 1-, 3-, and 5-year OS rates of 36.6%, 22.3%, and 12.0%, respectively. The median OS after partial hepatectomy (n = 86), chemotherapy (n = 36), liver transplantation (n = 17), and supportive care (n = 46) were 15, 10, 5 and 1.3 months, respectively. Small tumor size (<10 cm) was the only significant favorable factor for OS after partial hepatectomy (P = 0.012). CONCLUSIONS Despite the dismal prognosis, partial hepatectomy could prolong the survival of hepatic angiosarcoma patients, particularly those with tumors <10 cm. Chemotherapy could be an option for unresectable disease. Liver transplantation is not a recommendable option for the management of this malignancy.
Collapse
Affiliation(s)
- De-Bang Li
- Department III of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Xiao-Ying Si
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Tao Wan
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Yan-Ming Zhou
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen 361003, China.
| |
Collapse
|
2
|
Tran Minh M, Mazzola A, Perdigao F, Charlotte F, Rousseau G, Conti F. Primary hepatic angiosarcoma and liver transplantation: Radiological, surgical, histological findings and clinical outcome. Clin Res Hepatol Gastroenterol 2018; 42:17-23. [PMID: 28416360 DOI: 10.1016/j.clinre.2017.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/09/2017] [Indexed: 02/04/2023]
Abstract
Angiosarcoma is a rare type of soft tissue sarcoma that accounts for less than 1% of all sarcomas and only 2% of all primary hepatic tumours. Thorotrast, arsenic, and vinyl chloride monomer are frequently listed as occupational exposure risks. The estimated latency is long (10-40 years) in occupational cases and very long (60 years or more) in non-occupational cases. The symptoms and CT-scan appearance of hepatic angiosarcoma (HAS) are non-specific. We present a case of a 65-year-old Caucasian male with history of cryptogenic cirrhosis, low alpha-foetoprotein levels and a single, 4-cm nodule of potential atypical hepatocellular carcinoma (no washout at MRI and CT-scan) in segment VIII. Laparoscopic radiofrequency ablation (a biopsy of the neoplastic lesion was technically impossible) was performed, followed by liver transplantation (LT) 6 months later. High-grade multifocal HAS was found in the explanted liver, with extensive involvement of the venous portal structures. No complications were observed during the postoperative course, and initial immunosuppression included tacrolimus, mycophenolate mofetil and corticosteroids. Because of the histological findings, tacrolimus was switched to everolimus as the main immunosuppressive drug one month after LT. Despite this conversion, the patient developed bone metastases 3 months after LT and peritoneal carcinosis one month later. This case report suggests that everolimus conversion does not inhibit the development of tumour metastases. Consequently, HAS remains an absolute contraindication to LT because of the poor outcome. If LT has been performed for incidental HAS, new molecular therapies (e.g. vascular endothelial growth factor antagonists) should be considered immediately after LT to improve the outcome.
Collapse
Affiliation(s)
- M Tran Minh
- Unité Médicale de Transplantation Hépatique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France; Medicina Traslazionale, Università Piemonte Orientale Amedeo Avogrado, Novara, Italy
| | - A Mazzola
- Unité Médicale de Transplantation Hépatique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France
| | - F Perdigao
- Service de Chirurgie Hépatobiliaire et Transplantation Hépatique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France
| | - F Charlotte
- Service d'Anatomie et Cytologie Pathologique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France
| | - G Rousseau
- Service de Chirurgie Hépatobiliaire et Transplantation Hépatique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France
| | - F Conti
- Unité Médicale de Transplantation Hépatique, Hôpital Pitié-Salpétrière, AP-HP, 75013 Paris, France; UMR_S 938, CDR Saint-Antoine, Sorbonne Universités, UPMC Université Paris 06, 75005 Paris, France.
| |
Collapse
|
3
|
Musella M, Milone M, Maietta P, Bianco P, Pisapia A, Gaudioso D, Palumbo R. Bariatric surgery is not contraindicated in obese patients suffering from glycogen storage disease type IXa. A case report with follow-up at three years. Int J Surg Case Rep 2014; 5:686-8. [PMID: 25194605 PMCID: PMC4189068 DOI: 10.1016/j.ijscr.2014.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/17/2014] [Accepted: 06/15/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Glucose storage disease type IXa (GSD IXa) is an uncommon condition presenting with childhood onset hepatomegaly, growth retardation, and often, fasting ketosis and hypoglycemia. Despite its benign course, the lack of dietary counseling may favor uncontrolled weight gain. We investigated the efficacy of bariatric surgery in one 17 years old female suffering from GSD IXa and morbid obesity. PRESENTATION OF CASE The diagnosis was GSD type IXa in a patient with a body mass index (BMI) of 45.5 kg/m2. Onset of hypoglycemia was reported twice each month. She was treated her implanting an adjustable gastric banding through laparoscopy. Three years after surgery the patient presents a BMI of 30.1 kg/m2 and an excess of weight loss (EWL) of 71.1%. Only once, following surgery, she had to deflate her band to allow a faster transit of food through her stomach, thus reaching a prompt euglycemic condition, due to an incoming hypoglycemic crisis. DISCUSSION Laparoscopic adjustable gastric banding (LAGB) is one of the most used approaches to treat morbid obesity. It is a restrictive procedure unable to affect the absorption of any nutrient, presenting a very low intra and perioperative complication rate. In our GSD IXa patient, it offered a prompt modification of food intake restriction whenever requested, thus avoiding hypoglycemia. CONCLUSION LAGB is effective in determining weight loss without inducing significant side effects or worsening hypoglycemia, in this morbid obese patient, suffering from GSD type IXa.
Collapse
Affiliation(s)
- Mario Musella
- Advanced Biomedical Sciences Department - General Surgery, "Federico II" University, Naples, Italy.
| | - Marco Milone
- Advanced Biomedical Sciences Department - General Surgery, "Federico II" University, Naples, Italy
| | - Paola Maietta
- Advanced Biomedical Sciences Department - General Surgery, "Federico II" University, Naples, Italy
| | - Paolo Bianco
- Advanced Biomedical Sciences Department - General Surgery, "Federico II" University, Naples, Italy
| | - Anna Pisapia
- Advanced Biomedical Sciences Department - General Surgery, "Federico II" University, Naples, Italy
| | - Dario Gaudioso
- Advanced Biomedical Sciences Department - General Surgery, "Federico II" University, Naples, Italy
| | - Rubina Palumbo
- Advanced Biomedical Sciences Department - General Surgery, "Federico II" University, Naples, Italy
| |
Collapse
|
4
|
Hepatic hemangiosarcoma: an absolute contraindication to liver transplantation--the European Liver Transplant Registry experience. Transplantation 2013; 95:872-7. [PMID: 23354302 DOI: 10.1097/tp.0b013e318281b902] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liver transplantation (LT) is performed for hemangiosarcoma (HAS) despite disappointing results. METHODS Retrospective study of 14 males and 8 females reported to the European Liver Transplant Registry. In view of the difficult differential diagnosis between HAS and hemangioendothelioma (HE), the study was deliberately restricted to the period 1986 to 2004 to allow comparison of clinical and biochemical behavior of HAS and HE liver recipients transplanted during the same time period. RESULTS Clinical signs, symptoms, and biochemical parameters differed significantly. Pre-LT diagnosis of HAS was made in only 5 of 16 (31%) biopsied patients. HE (7 patients) and hepatocellular cancer (2 patients) were confounding diagnoses leading to LT. Extrahepatic disease was present at time of LT in 4 (19%) patients. Giant invalidating tumor (5 HAS, 1 with Budd-Chiari syndrome [BCS], and 10 supposed epithelioid hemangioendothelioma, 1 with BCS), acute BCS of unknown origin (2 patients), chronic liver failure (4 patients), and solitary hepatocellular cancer (1 patient) were the main indications for LT. Overall survival was 7.2±2.6 months; no patient survived after 23 months. Recurrence was diagnosed after 5.0±2.6 months. Seventeen (77.2%) patients died of tumor recurrence, and the remaining 5 patients died of early infections. CONCLUSIONS HAS is an absolute contraindication to LT due to the poor outcome. When dealing with the difficult differential diagnosis between HAS and HE, futile LT can be avoided by taking into consideration their distinct clinical and biochemical behaviors as well as a 6-month wait-list observation period. This time period enables the evaluation of HAS disease progression without compromising prognosis of HE patients, thereby allowing to avoid organ wastage.
Collapse
|
5
|
Abstract
For many patients with malignant disease of the liver, liver transplantation offers the only opportunity for clinical cure or prolonged palliation. As a result of organ scarcity, patients are increasingly selected on the basis of tumour stage and with the predictable likelihood of prolonged survival in mind. Consequently, 3- and 5-year survival rates of 72% and 68% respectively have been described for patients transplanted with hepatocellular carcinoma for tumours measuring less than 5 cm in diameter or up to three in number. Moreover, many centres are developing adjuvant and neo-adjuvant therapeutic protocols to minimize the risks of disease recurrence following transplantation for malignancy. In this chapter, we review the current knowledge in relation to transplantation for hepatocellular carcinoma, fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, metastatic neuroendocrine tumours, secondary solid tumours and other rarer malignancies.
Collapse
Affiliation(s)
- M A Heneghan
- Institute of Liver Studies, King's College Hospital, London, UK
| | | |
Collapse
|
6
|
Loinaz C, Gómez R, González-Pinto I, Jiménez C, Manzanera M, Ochando F, Rodríguez A, Colina F, García I, Moreno E. A decade of liver transplantation in primary liver tumors. Transplant Proc 1998; 30:3296-7. [PMID: 9838457 DOI: 10.1016/s0041-1345(98)01036-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- C Loinaz
- Department of General Surgery, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
|
8
|
Farmer DG, Seu P, Swenson K, Economou J, Busuttil RW. Current and future treatment modalities for hepatocellular carcinoma. Clin Liver Dis 1997; 1:361-96, ix. [PMID: 15562574 DOI: 10.1016/s1089-3261(05)70276-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article reviews recent innovations in the treatment of Hepatocellular carcinoma (HCC), which, although a common malignancy, has often proved difficult to diagnose and treat effectively. The epidemiology and natural history of HCC are discussed, as well as treatments such as hepatic resection, liver transplantation, and cryosurgery, among others.
Collapse
Affiliation(s)
- D G Farmer
- Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, University of California, Los Angeles 90024-1749, USA
| | | | | | | | | |
Collapse
|
9
|
Abstract
Liver cancer is an uncommon indication for liver transplantation in children. Between 1986 and 1995, five children with hepatocellular cancer (HCC), three with hepatoblastoma (HEP), and one with sarcoma were referred to the transplant service. All nine tumors were considered unresectable. Four of the five children with HCC had underlying predisposing conditions (2 hepatitis B, 1 biliary atresia, 1 tyrosinemia). Preoperative evaluation of all patients included careful radiological screening and pretransplantation laparotomy for staging. Two patients with HCC were excluded from further consideration because of intraabdominal spread. Three patients had transplantation (mean age, 6.0 +/- 7.1 years), and all have survived for 1 to 5 years with no evidence of recurrence. Three patients with HEP were assessed (mean age 2.0 +/- 1 years); two had stage 4 disease and one had stage 3. All three received preoperative chemotherapy. The two with stage 4 had thoracotomies as part of their assessment. Two of three patients had a significant decrease in the size of the primary tumor during the waiting period. These two patients and one with stage 4 disease have survived more than 2 years since transplantation, with no recurrence. The third patient had recurrence within 2 months of transplantation. In summary, liver transplantation should be considered for all children who have unresectable hepatic malignancies, given the 83% survival rate and no evidence of tumor recurrence. Stage 4 disease in HEP does not necessarily exclude patients from transplantation. Early referral is encouraged so that tumor spread beyond the liver is minimized.
Collapse
Affiliation(s)
- R Superina
- Liver Transplant Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|