1
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Living donor liver transplantation in hepatocellular carcinoma: A single-center experiences. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.557019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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2
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Wang LY, Zheng SS. Advances in predicting the prognosis of hepatocellular carcinoma recipients after liver transplantation. J Zhejiang Univ Sci B 2018; 19:497-504. [PMID: 29971988 DOI: 10.1631/jzus.b1700156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the most prevalent malignant tumors worldwide. Liver transplantation (LT) is known as a curative and therapeutic modality. However, the survival rates of recipients after LT are still not good enough because of tumor recurrence. To improve the survival rates of recipients after LT, identifying predictive factors for prognosis after LT and establishing a model assessing prognosis are very important to HCC patients. There has recently been a lot of clinical and basic research on recurrence and prognosis after LT. Progress has been made, especially in selection criteria for LT recipients and risk factors for predicting prognosis after LT. Hangzhou criteria, in line with China's high current incidence rate of primary liver, are first proposed by Chinese scholars of LT, and are accepted world-wide, and make an important contribution to the development of LT.
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Affiliation(s)
- Li-Ying Wang
- Department of Ultrasound, Shaoxing Second Hospital, Shaoxing 312000, China
| | - Shu-Sen Zheng
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Health, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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3
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Itri JN, Raghavan K, Patel SB, Broder JC, Tierney S, Gray D, Burleson J, MacDonald S, Seidenwurm DJ. Developing Quality Measures for Diagnostic Radiologists: Part 2. J Am Coll Radiol 2018; 15:1366-1384. [DOI: 10.1016/j.jacr.2018.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 04/23/2018] [Accepted: 05/05/2018] [Indexed: 12/21/2022]
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4
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Ma KW, Chok KSH. Importance of surgical margin in the outcomes of hepatocholangiocarcinoma. World J Hepatol 2017; 9:635-641. [PMID: 28539991 PMCID: PMC5424293 DOI: 10.4254/wjh.v9.i13.635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/03/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the significance of resection margin width in the management of hepatocholangiocarcinoma (HCC-CC).
METHODS Data of consecutive patients who underwent hepatectomy for hepatic malignancies in the period from 1995 to 2014 were reviewed. Patients with pathologically confirmed HCC-CC were included for analysis. Demographic, biochemical, operative and pathological data were analyzed against survival outcomes.
RESULTS Forty-two patients were included for analysis. The median age was 53.5 years. There were 29 males. Hepatitis B virus was identified in 73.8% of the patients. Most patients had preserved liver function. The median preoperative indocyanine green retention rate at 15 min was 10.2%. The median tumor size was 6.5 cm. Major hepatectomy was required in over 70% of the patients. Hepaticojejunostomy was performed in 6 patients. No hospital death occurred. The median hospital stay was 13 d. The median follow-up period was 32 mo. The 5-year disease-free survival and overall survival were 23.6% and 35.4% respectively. Multifocality was the only independent factor associated with disease-free survival [P < 0.001, odds ratio 4, 95% confidence interval (CI): 1.9-8.0]. In patients with multifocal tumor (n = 20), resection margin of ≥ 1 cm was associated with improved 1-year disease-free survival (40% vs 0%; log-rank, P = 0.012).
CONCLUSION HCC-CC is a rare disease with poor prognosis. Resection margin of 1 cm or above was associated with improved survival outcome in patients with multifocal HCC-CC.
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5
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. J Vasc Interv Radiol 2014; 25:1691-705.e4. [PMID: 25442132 PMCID: PMC7660986 DOI: 10.1016/j.jvir.2014.08.027] [Citation(s) in RCA: 346] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/11/2014] [Accepted: 03/26/2014] [Indexed: 12/12/2022] Open
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215.
| | - Luigi Solbiati
- Department of Radiology, Ospedale Generale, Busto Arsizio, Italy
| | - Christopher L Brace
- Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David J Breen
- Department of Radiology, Southampton University Hospitals, Southampton, England
| | | | | | - Min-Hua Chen
- Department of Ultrasound, School of Oncology, Peking University, Beijing, China
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Thierry de Baère
- Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Gerald D Dodd
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Damian E Dupuy
- Department of Diagnostic Radiology, Rhode Island Hospital, Providence, Rhode Island
| | - Debra A Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Gianfelice
- Medical Imaging, University Health Network, Laval, Quebec, Canada
| | | | - Fred T Lee
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Edward Leen
- Department of Radiology, Royal Infirmary, Glasgow, Scotland
| | - Riccardo Lencioni
- Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy
| | - Peter J Littrup
- Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - David S Lu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John P McGahan
- Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, California
| | | | - Boris Nikolic
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Philippe L Pereira
- Clinic of Radiology, Minimally-Invasive Therapies and Nuclear Medicine, Academic Hospital Ruprecht-Karls-University Heidelberg, Heilbronn, Germany
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Hyunchul Rhim
- Department of Diagnostic Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Steven C Rose
- Department of Radiology, University of California, San Diego, San Diego, California
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | | | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael C Soulen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Bradford J Wood
- Radiology and Imaging Science, National Institutes of Health, Bethesda, Maryland
| | - S Nahum Goldberg
- Department of Radiology, Image-Guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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6
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Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD, Dupuy DE, Gervais DA, Gillams AR, Kane RA, Lee FT, Livraghi T, McGahan J, Phillips DA, Rhim H, Silverman SG, Solbiati L, Vogl TJ, Wood BJ, Vedantham S, Sacks D. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2009; 20:S377-90. [PMID: 19560026 DOI: 10.1016/j.jvir.2009.04.011] [Citation(s) in RCA: 350] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The field of interventional oncology with use of image-guided tumor ablation requires standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison between treatments that use different technologies, such as chemical (ethanol or acetic acid) ablation, and thermal therapies, such as radiofrequency (RF), laser, microwave, ultrasound, and cryoablation. This document provides a framework that will hopefully facilitate the clearest communication between investigators and will provide the greatest flexibility in comparison between the many new, exciting, and emerging technologies. An appropriate vehicle for reporting the various aspects of image-guided ablation therapy, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings, are outlined. Methods for standardizing the reporting of follow-up findings and complications and other important aspects that require attention when reporting clinical results are addressed. It is the group's intention that adherence to the recommendations will facilitate achievement of the group's main objective: improved precision and communication in this field that lead to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes. The intent of this standardization of terminology is to provide an appropriate vehicle for reporting the various aspects of image-guided ablation therapy.
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Affiliation(s)
- S Nahum Goldberg
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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7
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Briceño J, Ruiz J, Ciria R, Naranjo A, Sánchez-Hidalgo J, Luque A, Rufián S, de la Mata M, López-Cillero P. Factors Affecting Survival and Tumor Recurrence in Patients Transplanted for Hepatocellular Carcinoma and Coexistent Hepatitis C Virus. Transplant Proc 2008; 40:2990-3. [DOI: 10.1016/j.transproceed.2008.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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8
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Abstract
Good management of patients at risk for the development of hepatocellular carcinoma includes regular ultrasound surveillance, and aggressive management of lesions detected at ultrasound. Good radiology and good pathology are essential to the appropriate management of these small lesions. With good quality testing it is possible to cure the majority of HCCs using minimally invasive techniques such as radiofrequency ablation. Such an approach has the potential to convert HCC from a disease in which incidence more or less equaled mortality to one in which cure is frequently possible.
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9
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Delis SG, Madariaga J, Ciancio G. Combined liver and inferior vena cava resection for hepatic malignancy. J Surg Oncol 2007; 96:258-64. [PMID: 17443739 DOI: 10.1002/jso.20794] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The experience from a single center, in combined liver and inferior vena cava (IVC) resection for liver tumors, is presented. METHODS Twelve patients underwent a combined liver resection with IVC replacement. The median age was 45 years (range 35-67 years). Resections were carried out for hepatocellular carcinoma (n = 4), colorectal metastases (n = 6), and cholangiocarcinoma (n = 2). Liver resections included eight right lobectomies and four left trisegmentectomies. The IVC was reconstructed with ringed Gore-Tex tube graft. RESULTS No perioperative deaths were reported. The median operative blood transfusion requirement was 2 units (range 0-12 units) and the median operative time was 5 hr. Median hospital stay was 10 days (range 8-25 days). Three patients had evidence of postoperative liver failure, resolved with supportive management. Two patients developed bile leaks, resolved conservatively. With a median follow up of 24 months, all vascular reconstructions were patent and no evidence of graft infection was documented. CONCLUSIONS Aggressive surgical management of liver tumors, offer the only hope for cure or palliation. We suggest that liver resection with vena cava replacement may be performed safely, with acceptable morbidity, by specialized surgical teams.
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Affiliation(s)
- Spiros G Delis
- Department of Surgery, Division of Transplantation, University of Miami School of Medicine, Miami, Florida 33101, USA.
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10
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Abstract
This article reviews methodological issues around screening for hepatocellular carcinoma, and discusses selection of the at-risk group, which screening test to use, and how frequently it should be applied. Screening of patients at risk for hepatocellular carcinoma should be undertaken using ultrasonography applied at six-month intervals. Patients at risk include all those with cirrhosis, and certain non-cirrhotic patients withchronic hepatitis B. In this population, screening has been shown to reduce disease-specific mortality. Although data do not exist for other populations, screening is nonetheless advised because small cancers can be cured with appreciable frequency.
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11
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Aydin U, Yazici P, Sozbilen M, Kece C, Tamsel S, Kilic M. Patient with hepatocellular carcinoma on the waiting list for liver transplantation: abdominal seeding due to prior surgery: a case report. Transplant Proc 2007; 39:1688-90. [PMID: 17580221 DOI: 10.1016/j.transproceed.2006.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Accepted: 11/16/2006] [Indexed: 10/23/2022]
Abstract
Hepatocellular cancer (HCC) is the most common primary malignant hepatic tumor that accounts for over 80% of primary liver tumors. Hepatic resection is a well-accepted therapy for HCC, but 70% to 100% of patients, depending on patient selection, baseline tumor characteristics, and follow-up duration, develop cancer recurrence after resective surgery. Orthotropic liver transplantation is considered more appropriate in cases with HCC related to cirrhosis. Both procedures may result in recurrence. In some cases, diagnosis of recurrent HCC is difficult because of unexpected localization of the tumor. For these patients, aggressive diagnostic tests might be useful for appropriate therapy. We report a case of a 48-year-old man undergoing resection for HCC, who experienced early recurrence of HCC in the pelvic region.
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Affiliation(s)
- U Aydin
- Ege University School of Medicine, Organ Transplantation and Research Center, Izmir, Turkey.
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12
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Tevar AD, Succop P, Schneider CR, Thambi-Pillai T, Thomas MJ, Neff G, Weber F, Rudich SM, Woodle ES, Buell JF. Liver transplantation for primary and metastatic hepatic malignancy: a single center experience. Surgery 2006; 139:535-41. [PMID: 16627064 DOI: 10.1016/j.surg.2005.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Revised: 09/15/2005] [Accepted: 09/22/2005] [Indexed: 11/20/2022]
Affiliation(s)
- Amit D Tevar
- Division of Transplantation, Department of Surgery, University of Cincinnati, Ohio 45267-0558, USA
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13
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Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD, Dupuy DE, Gervais D, Gillams AR, Kane RA, Lee FT, Livraghi T, McGahan J, Phillips DA, Rhim H, Silverman SG. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2005; 16:765-78. [PMID: 15947040 DOI: 10.1097/01.rvi.0000170858.46668.65] [Citation(s) in RCA: 246] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The field of interventional oncology with use of image-guided tumor ablation requires standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison between treatments that use different technologies, such as chemical (ethanol or acetic acid) ablation, and thermal therapies, such as radiofrequency (RF), laser, microwave, ultrasound, and cryoablation. This document provides a framework that will hopefully facilitate the clearest communication between investigators and will provide the greatest flexibility in comparison between the many new, exciting, and emerging technologies. An appropriate vehicle for reporting the various aspects of image-guided ablation therapy, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings, are outlined. Methods for standardizing the reporting of follow-up findings and complications and other important aspects that require attention when reporting clinical results are addressed. It is the group's intention that adherence to the recommendations will facilitate achievement of the group's main objective: improved precision and communication in this field that lead to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes. The intent of this standardization of terminology is to provide an appropriate vehicle for reporting the various aspects of image-guided ablation therapy.
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Affiliation(s)
- S Nahum Goldberg
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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14
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Affiliation(s)
- Jordi Bruix
- BCLC Group. Liver Unit. Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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15
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Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD, Dupuy DE, Gervais D, Gillams AR, Kane RA, Lee FT, Livraghi T, McGahan J, Phillips DA, Rhim H, Silverman SG. Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 2005; 235:728-39. [PMID: 15845798 PMCID: PMC3406173 DOI: 10.1148/radiol.2353042205] [Citation(s) in RCA: 515] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The field of interventional oncology with use of image-guided tumor ablation requires standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison between treatments that use different technologies, such as chemical (ethanol or acetic acid) ablation, and thermal therapies, such as radiofrequency, laser, microwave, ultrasound, and cryoablation. This document provides a framework that will hopefully facilitate the clearest communication between investigators and will provide the greatest flexibility in comparison between the many new, exciting, and emerging technologies. An appropriate vehicle for reporting the various aspects of image-guided ablation therapy, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings, are outlined. Methods for standardizing the reporting of follow-up findings and complications and other important aspects that require attention when reporting clinical results are addressed. It is the group's intention that adherence to the recommendations will facilitate achievement of the group's main objective: improved precision and communication in this field that lead to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes.
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Affiliation(s)
- S Nahum Goldberg
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
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16
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Koh KC, Lee H, Choi MS, Lee JH, Paik SW, Yoo BC, Rhee JC, Cho JW, Park CK, Kim HJ. Clinicopathologic features and prognosis of combined hepatocellular cholangiocarcinoma. Am J Surg 2005; 189:120-5. [PMID: 15701504 DOI: 10.1016/j.amjsurg.2004.03.018] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Revised: 03/20/2004] [Accepted: 03/20/2004] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinicopathologic features and prognosis of combined hepatocellular cholangiocarcinoma (HCC-CC) have not been established. METHODS Data of patients who underwent surgical resection for HCC-CC were compared with those of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (CC) patients. RESULTS The prevalence of hepatitis B positivity (54.0%) and that of cirrhosis (54.2%) in the HCC-CC group were of intermediate tendency between the HCC group and the CC group. The HCC-CC group presented with a higher prevalence of multiplicity and microvascular emboli and portal vein or hepatic vein invasion, but a lower prevalence of capsular formation compared with the other groups. One- and 3-year survival rates in the HCC-CC group (81.9% and 47.0%, respectively) were lower than those in the HCC group and higher than those in the CC group. The cumulative recurrence rates at 6 months and at 1 year in the HCC-CC group (25.0% and 33.3%, respectively) were higher than those in the HCC group and lower than those in the CC group. CONCLUSIONS The HCC-CC group has distinct clinicopathologic features compared with the HCC or CC groups. In addition, the HCC-CC group has a prognosis that is better than the CC group but worse than the HCC group.
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Affiliation(s)
- Kwang Cheol Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Kangnam-ku, Seoul, Korea 135-710
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17
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Abstract
There is currently no evidence that screening patients at risk for hepatocellular carcinoma reduces mortality from the disease. Nonetheless, screening is widely practiced. Screening is a process that includes selecting patients, applying screening tests, deciding on recall policies, and subsequently proving or disproving the presence of cancer. The literature on screening for hepatocellular carcinoma is confusing at best, and does not adequately consider the many biases that result from uncontrolled and retrospective studies. Nonetheless, screening can be justified because it is likely that mortality is decreased by adequate treatment of small cancers, particularly in the era of liver transplantation. False-positive screening test results are common. Once an abnormal screening result is obtained there is little guidance from the literature as to how patients should be investigated further, nor about how to determine whether the screening test result was a false-positive. This should at minimum include short interval follow-up with CT scans and MRI's.
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Affiliation(s)
- Morris Sherman
- University of Toronto and Toronto General Hospital, 200 Elizabeth Street, Toronto, Ont., Canada M5G 2C4.
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18
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Shimoda M, Ghobrial RM, Carmody IC, Anselmo DM, Farmer DG, Yersiz H, Chen P, Dawson S, Durazo F, Han S, Goldstein LI, Saab S, Hiatt J, Busuttil RW. Predictors of survival after liver transplantation for hepatocellular carcinoma associated with Hepatitis C. Liver Transpl 2004; 10:1478-86. [PMID: 15558585 DOI: 10.1002/lt.20303] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The efficacy of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) associated with hepatitis C virus (HCV) is not well defined. This study examines the variables that may determine the outcome of OLT for HCC in HCV patients. From 1990 to 1999, 463 OLTs were performed for HCV cirrhosis. Of these patients, 67 with concurrent HCC were included in the study. Univariate and multivariate analyses considered the following variables: gender, pTNM stage, tumor size, number of nodules, vascular invasion, incidental tumors, adjuvant chemotherapy, preoperative chemoembolization, alpha-fetoprotein (AFP) tumor marker, lobar distribution, and histological grade. Overall OLT survival of HCV patients diagnosed with concomitant HCC was significantly lower when compared to patients who underwent OLT for HCV alone at 1, 3, and 5 years (75%, 71%, and 55% versus 84%, 76%, and 75%, respectively; P < 0.01). Overall survival of patients with stage I HCC was significantly better than patients with stage II, III, or IV (P < .05). Eleven of 67 patients developed tumor recurrence. Sites of recurrence included transplanted liver (5), lung (5), and bone (1). Twenty-four of 67 patients (36%) died during the follow-up time. Causes of deaths included recurrent HCC in 8 of 24 patients (12%) and recurrent HCV in 3 of 24 patients (4.5%), whereas 13 (19.5%) patients died from causes that were unrelated to HCV or HCC. Both univariate and multivariate analysis demonstrated that pTNM status (I versus II, III, and IV; P < .05) was a reliable prognostic indicator for patient survival. Presence of vascular invasion (P = .0001) and advanced pTNM staging (P = .038) increased risk of recurrence. Multivariate analysis showed that pretransplant chemoembolization and adjuvant chemotherapy reduced risk of death after OLT in HCC recipients. In conclusion, this study demonstrates the effectiveness of OLT for patients with HCC in a large cohort of chronic HCV patients. Advanced tumor stage, and particularly vascular invasion, are poor prognostic indicators for tumor recurrence. Early pTNM stage, adjuvant chemotherapy, and preoperative chemoembolization were associated with positive outcomes for patients who underwent OLT for concomitant HCV and HCC.
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Affiliation(s)
- Mitsugi Shimoda
- Dumont-UCLA Liver Transplant Center, Department of Surgery, UCLA School of Medicine, 90095, USA
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19
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Ott DJ. Percutaneous radio-frequency liver tumor ablation: what are the risks? Am J Gastroenterol 2003; 98:2564-5. [PMID: 14638365 DOI: 10.1111/j.1572-0241.2003.08733.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- David J Ott
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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20
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Goldberg SN, Charboneau JW, Dodd GD, Dupuy DE, Gervais DA, Gillams AR, Kane RA, Lee FT, Livraghi T, McGahan JP, Rhim H, Silverman SG, Solbiati L, Vogl TJ, Wood BJ. Image-guided tumor ablation: proposal for standardization of terms and reporting criteria. Radiology 2003; 228:335-45. [PMID: 12893895 DOI: 10.1148/radiol.2282021787] [Citation(s) in RCA: 324] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The field of image-guided tumor ablation requires standardization of terms and reporting criteria to facilitate effective communication of ideas and appropriate comparison between treatments with different technologies, such as chemical ablation (ethanol or acetic acid) and thermal therapies, such as radiofrequency, laser, microwave, ultrasound, and cryoablation. On the basis of this premise, a working committee was established with the goal of producing a proposal on such standardization. The intent of the Working Group is to provide a framework that will facilitate the clearest communication between investigators and will provide the greatest flexibility in comparisons between the many new, exciting, and emerging technologies. The members of the Working Group now propose a vehicle for reporting the various aspects of image-guided ablation therapy, including classifications of therapies and procedures, appropriate descriptors of image guidance, and terms to define imaging and pathologic findings. Methods for standardizing the reporting of follow-up findings and complications and other important aspects that require attention when reporting clinical results are addressed. It is the group's hope and intention that adherence to the recommendations of this proposal will facilitate achievement of the group's main objective: improved precision and communication in this field that lead to more accurate comparison of technologies and results and ultimately to improved patient outcomes.
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Affiliation(s)
- S Nahum Goldberg
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
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Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 2003; 226:441-51. [PMID: 12563138 DOI: 10.1148/radiol.2262012198] [Citation(s) in RCA: 917] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To report complications encountered by members of a collaborative group who performed radio-frequency (RF) ablation in patients with focal liver cancer. MATERIALS AND METHODS Members of 41 Italian centers that were part of a collaborative group used a percutaneous internally cooled RF ablation technique and a standardized protocol for follow-up. They completed a questionnaire regarding number of deaths, presumed cause of death, and likelihood of its relationship to the RF procedure; number and types of major complications; and types of minor complications and side effects. Enrollment included 2,320 patients with 3,554 lesions (size, 3.1 cm +/- 1.1 [SD] in diameter): 1,610 had hepatocellular carcinoma with chronic liver disease; 693 had metastases, predominantly from colorectal cancer (n = 501); and 17 had cholangiocellular carcinoma. Number and characteristics of complications (ie, deaths and major and minor complications) attributed to the procedure were reported. Data were subsequently analyzed with analysis of variance to determine whether the major complication rate was related to tumor size, number of ablation sessions, or electrode type (single or cluster). RESULTS In total, 3,554 lesions were treated. Six deaths (0.3%) were noted, including two caused by multiorgan failure following intestinal perforation; one case each of septic shock following Staphylococcus aureus-caused peritonitis, massive hemorrhage following tumor rupture, liver failure following stenosis of right bile duct; and one case of sudden death of unknown cause 3 days after the procedure. Fifty (2.2%) patients had additional major complications. The most frequent of these were peritoneal hemorrhage, neoplastic seeding, intrahepatic abscesses, and intestinal perforation. An increased number of RF sessions were related to a higher rate of major complications (P <.01), whereas the number of complications was not significantly different when tumor size or electrode type were compared. Minor complications were observed in less than 5% of patients. CONCLUSION Results of this study confirm that RF ablation is a relatively low-risk procedure for the treatment of focal liver tumors.
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Affiliation(s)
- Tito Livraghi
- Department of Radiology, Ospedale Civile, Vimercate, Italy
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Molmenti EP, Klintmalm GB. Liver transplantation in association with hepatocellular carcinoma: an update of the International Tumor Registry. Liver Transpl 2002; 8:736-48. [PMID: 12200772 DOI: 10.1053/jlts.2002.34879] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma is an epithelial tumor derived from hepatocytes that accounts for more than 80% of all primary hepatic tumors. The severity of the underlying disease is almost always the key factor in deciding whether to consider liver resection or transplantation as its treatment. Data in our registry corresponding to almost 800 patients from transplant centers throughout the world showed that patient survival after liver transplantation was significantly affected by histologic grade, tumor size >5 cm, and the presence of positive nodes. Recurrence-free survival showed a correlation with tumor size >5 cm, positive nodes, bilobar spread, and vascular invasion. At the present time, 59% of patients in our registry are alive, 84% of whom are free of tumor. Of those who died, half did so without evidence of tumor.
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Affiliation(s)
- Ernesto P Molmenti
- Baylor University Medical Center, Transplantation Services, Dallas, TX 75246, USA
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Hemming A, Gallinger S. Liver. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
The early survival of patients transplanted for liver and biliary cancer is excellent, but the overall mid- to long-term survival is poor. In an era of severe donor organ shortage, it is not justified to allocate donor liver to patients with a suboptimal outcome. Patients with non-resectable hepatocellular carcinoma in a non-cirrhotic liver should not be assigned to liver transplantation. Although patients with the fibrolamellar variant have a somewhat better outlook, they are still likely to recur, and the young age of many of these patients is likely to overwhelm any rational approach. The results of transplantation for early-stage hepatocellular carcinoma in a cirrhotic liver are similar to those achieved with benign disease. The inclusion of such cases as a group is justified, but attempts should be made to resect tumors whenever possible and to not assign the entire group to transplantation as the first and only option. The value of pre- and postoperative adjuvant therapy for this group is still under debate, but the present waiting period is so long that some form of therapy to slow growth and prevent dissemination of tumor cells is probably required. The results following transplantation for cholangiocarcinoma can only be regarded as dismal, and the diagnosis of cholangiocarcinoma is a contraindication for the procedure. Liver transplantation has a definite place in the treatment of epithelioid hemangioendothelioma and unresectable chemo-responsive hepatoblastoma when confined to the liver, and in a limited number of metastatic neuroendocrine tumors.
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Affiliation(s)
- R W Strong
- Department of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
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Affiliation(s)
- N A Dower
- Department of Pediatrics, University of Alberta, Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta, Canada T6G 2R7
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