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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2011, Vol. 5 Issue (3) : 271-276     DOI: 10.1007/s11684-011-0148-4
REVIEW |
Towards the optimization of management of hepatocellular carcinoma
Xi Feng1, Madhava Pai1, Malkhaz Mizandari2, Tinatin Chikovani2, Duncan Spalding1, Long Jiao1, Nagy Habib1()
1. Division of Surgery, Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; 2. Tbilisi 1st Hospital University Clinic, High Technology Medical Center, Tbilisi 0144, Georgia
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Abstract  

Hepatocellular carcinoma (HCC) is the fifth most common neoplasm in the world, closely correlated with viral hepatitis and liver cirrhosis. The vast majority of HCC patients present at a late stage and are unsuitable for surgery due to limited liver functional reserve. Tumors can involve major vessels or hilar structures, necessitating major liver resection and/or rendering liver resection unfeasible. A series of new technologies have been developed to optimise HCC management. Stem cell therapy improves impaired liver functional reserve prior to liver resection. Intravascular radiofrequency ablation recanalises the portal vein invaded by tumour thrombus and endobiliary radiofrequency ablation restores and extends biliary patency of the bile duct invaded by malignancy. Laparoscopic radiofrequency assisted liver resection minimizes blood loss and avoids liver warm ischemia, while increasing parenchymal sparing. These benefits combined maximize the safety of liver resection.

Keywords management      hepatocellular carcinoma (HCC)      radiofrequency (RF) ablation      laparoscopic liver resection      stem cell      intravascular RF ablation      endobiliary RF ablation     
Corresponding Authors: Habib Nagy,Email:nagy.habib@imperial.ac.uk   
Issue Date: 05 September 2011
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-011-0148-4     OR     http://academic.hep.com.cn/fmd/EN/Y2011/V5/I3/271
Fig.1  Pre and post VesCoag ablation of the blood supply to a renal metastasis in segment III.
Fig.2  (A)After application of VesOpen, the blood flow of the right portal vein was restored ;( B) HCC+ tumor thrombus in right portal vein prior to application of VesOpen.
Fig.3  (A) Before application of EndoHPB, the biliary tree was totally obstructed;( B) After application of EndoHPB, the continuity of the biliary tree was restored.
Fig.4  Illustration of change of bilirubin of 9 patients who were Child’s B, 7 were converted to Child’s A after stem cell therapy.
Fig.5  The steps to achieve liver resection using laparoscopic Habib 4X.
Fig.6  Ideal steps toward optimisation of advanced HCC patient.
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