Towards the optimization of management of hepatocellular carcinoma

doi:10.1007/s11684-011-0148-4

Front Med

2011, Vol. 5

Issue (3) : 271-276 https://doi.org/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 Author(s): Habib Nagy,Email:nagy.habib@imperial.ac.uk

Issue Date: 05 September 2011

Cite this article:

Xi Feng,Madhava Pai,Malkhaz Mizandari, et al. Towards the optimization of management of hepatocellular carcinoma[J]. Front Med, 2011, 5(3): 271-276.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-011-0148-4
https://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.

1	Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2003; 362(9399): 1907–1917 doi: 10.1016/S0140-6736(03)14964-1 pmid:14667750
2	Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer 2001; 94(2): 153–156 doi: 10.1002/ijc.1440 pmid:11668491
3	Simonetti RG, Cammà C, Fiorello F, Politi F, D’Amico G, Pagliaro L. Hepatocellular carcinoma: a worldwide problem and the major risk factors. Dig Dis Sci 1991; 36(7): 962–972 1649041 doi: 10.1007/BF01297149
4	Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 2004; 130(7): 417–422 doi: 10.1007/s00432-004-0552-0 pmid:15042359
5	Kuo YH, Lu SN, Chen CL, Cheng YF, Lin CY, Hung CH, Chen CH, Changchien CS, Hsu HC, Hu TH, Lee CM, Wang JH. Hepatocellular carcinoma surveillance and appropriate treatment options improve survival for patients with liver cirrhosis. Eur J Cancer 2010; 46(4): 744–751 doi: 10.1016/j.ejca.2009.12.018 pmid:20060710
6	Llovet JM, Bruix J, Gores GJ. Surgical resection versus transplantation for early hepatocellular carcinoma: clues for the best strategy. Hepatology 2000; 31(4): 1019–1021 doi: 10.1053/he.2000.6959 pmid:10733561
7	Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, Ascher NL, Roberts JP. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001; 33(6): 1394–1403 doi: 10.1053/jhep.2001.24563 pmid:11391528
8	Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg 2002; 235(3): 373–382 doi: 10.1097/00000658-200203000-00009 pmid:11882759
9	Breedis C, Young G. The blood supply of neoplasms in the liver. Am J Pathol 1954; 30(5): 969–977 pmid:13197542
10	Cammà C, Schepis F, Orlando A, Albanese M, Shahied L, Trevisani F, Andreone P, Craxì A, Cottone M. Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology 2002; 224(1): 47–54 doi: 10.1148/radiol.2241011262 pmid:12091661
11	Khorsandi S, Kysela P, Valek V, Olufemi O, Lázár I, Prochazka V, Zacharoulis D, Rountas C, Habib N. Initial data on a novel endovascular radiofrequency catheter when used for arterial occlusion in liver cancer. Eur Surg 2009; 41(3): 104–108 doi: 10.1007/s10353-009-0463-z
12	Khorsandi S, Zacharoulis D, Vavra P, Navarra G, Kysela P, Habib N. The modern use of radiofrequency energy in surgery, endoscopy and interventional radiology. Eur Surg 2008; 40(5): 204–210 doi: 10.1007/s10353-008-0427-8
13	Lau WY, Leung JWC, Li AKC. Management of hepatocellular carcinoma presenting as obstructive jaundice. Am J Surg 1990; 160(3): 280–282 doi: 10.1016/S0002-9610(06)80023-1 pmid:2168129
14	Loew BJ, Howell DA, Sanders MK, Desilets DJ, Kortan PP, May GR, Shah RJ, Chen YK, Parsons WG, Hawes RH, Cotton PB, Slivka AA, Ahmad J, Lehman GA, Sherman S, Neuhaus H, Schumacher BM. Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial. Gastrointest Endosc 2009; 70(3): 445–453 doi: 10.1016/j.gie.2008.11.018 pmid:19482279
15	Steel AW, Postgate AJ, Khorsandi S, Nicholls J, Jiao L, Vlavianos P, Habib N, Westaby D. Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc 2011; 73(1): 149–153 doi: 10.1016/j.gie.2010.09.031 pmid:21184881
16	Alison MR, Poulsom R, Jeffery R, Dhillon AP, Quaglia A, Jacob J, Novelli M, Prentice G, Williamson J, Wright NA. Hepatocytes from non-hepatic adult stem cells. Nature 2000; 406(6793): 257 doi: 10.1038/35018642 pmid:10917519
17	Preston SL, Alison MR, Forbes SJ, Direkze NC, Poulsom R, Wright NA. The new stem cell biology: something for everyone. Mol Pathol 2003; 56(2): 86–96 doi: 10.1136/mp.56.2.86 pmid:12665626
18	Theise ND, Nimmakayalu M, Gardner R, Illei PB, Morgan G, Teperman L, Henegariu O, Krause DS. Liver from bone marrow in humans. Hepatology 2000; 32(1): 11–16 doi: 10.1053/jhep.2000.9124 pmid:10869283
19	Gordon MY, Levicar N, Pai M, Bachellier P, Dimarakis I, Al-Allaf F, M’Hamdi H, Thalji T, Welsh JP, Marley SB, Davies J, Dazzi F, Marelli-Berg F, Tait P, Playford R, Jiao L, Jensen S, Nicholls JP, Ayav A, Nohandani M, Farzaneh F, Gaken J, Dodge R, Alison M, Apperley JF, Lechler R, Habib NA. Characterization and clinical application of human CD34⁺ stem/progenitor cell populations mobilized into the blood by granulocyte colony-stimulating factor. Stem Cells 2006; 24(7): 1822–1830 doi: 10.1634/stemcells.2005-0629 pmid:16556705
20	Levicar N, Pai M, Habib NA, Tait P, Jiao LR, Marley SB, Davis J, Dazzi F, Smadja C, Jensen SL, Nicholls JP, Apperley JF, Gordon MY. Long-term clinical results of autologous infusion of mobilized adult bone marrow derived CD34⁺ cells in patients with chronic liver disease. Cell Prolif 2008; 41(Suppl 1): 115–125 doi: 10.1111/j.1365-2184.2008.00491.x pmid:18181952
21	Pai M, Zacharoulis D, Milicevic MN, Helmy S, Jiao LR, Levicar N, Tait P, Scott M, Marley SB, Jestice K, Glibetic M, Bansi D, Khan SA, Kyriakou D, Rountas C, Thillainayagam A, Nicholls JP, Jensen S, Apperley JF, Gordon MY, Habib NA. Autologous infusion of expanded mobilized adult bone marrow-derived CD34⁺ cells into patients with alcoholic liver cirrhosis. Am J Gastroenterol 2008; 103(8): 1952–1958 doi: 10.1111/j.1572-0241.2008.01993.x pmid:18637092
22	am Esch JS 2nd, Knoefel WT, Klein M, Ghodsizad A, Fuerst G, Poll LW, Piechaczek C, Burchardt ER, Feifel N, Stoldt V, Stockschl?der M, Stoecklein N, Tustas RY, Eisenberger CF, Peiper M, H?ussinger D, Hosch SB. Portal application of autologous CD133⁺ bone marrow cells to the liver: a novel concept to support hepatic regeneration. Stem Cells 2005; 23(4): 463–470 doi: 10.1634/stemcells.2004-0283 pmid:15790766
23	Cuesta MA, Meijer S, Paul MA, de Brauw LM. Limited laparoscopic liver resection of benign tumors guided by laparoscopic ultrasonography: report of two cases. Surg Laparosc Endosc 1995; 5(5): 396–401 pmid:8845986
24	Pai M, Navarra G, Ayav A, Sommerville C, Khorsandi SK, Damrah O, Jiao LR, Habib NA. Laparoscopic Habib 4X: a bipolar radiofrequency device for bloodless laparoscopic liver resection. HPB (Oxford) 2008; 10(4): 261–264 doi: 10.1080/13651820802167862 pmid:18773100
25	Weber JC, Navarra G, Jiao LR, Nicholls JP, Jensen SL, Habib NA. New technique for liver resection using heat coagulative necrosis. Ann Surg 2002; 236(5): 560–563 doi: 10.1097/00000658-200211000-00004 pmid:12409660
26	Ayav A, Jiao L, Dickinson R, Nicholls J, Milicevic M, Pellicci R, Bachellier P, Habib N. Liver resection with a new multiprobe bipolar radiofrequency device. Arch Surg 2008; 143(4): 396–401 , discussion 401 doi: 10.1001/archsurg.143.4.396 pmid:18427028
27	Ayav A, Jiao LR, Habib NA. Bloodless liver resection using radiofrequency energy. Dig Surg 2007; 24(4): 314–317 doi: 10.1159/000103664 pmid:17657158
28	Jiao LR, Ayav A, Navarra G, Sommerville C, Pai M, Damrah O, Khorsandi S, Habib NA. Laparoscopic liver resection assisted by the laparoscopic Habib Sealer. Surgery 2008; 144(5): 770–774 doi: 10.1016/j.surg.2008.08.005 pmid:19081019
29	Akyildiz HY, Morris-Stiff G, Aucejo F, Fung J, Berber E. Techniques of radiofrequency-assisted precoagulation in laparoscopic liver resection. Surg Endosc 2011; 25(4): 1143–1147 doi: 10.1007/s00464-010-1330-5 pmid:20844897

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