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World Journal of Surgery

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01-02-2015 | Original Scientific Report

Impact of Severe Oesophagogastric Varices on Liver Resection for Hepatocellular Carcinoma in Cirrhotic Patients

Authors: Hsiao-Tien Liu, Shao-Bin Cheng, Cheng-Chung Wu, Hong-Zen Yeh, Chi-Sen Chang, John Wang

Published in: World Journal of Surgery | Issue 2/2015

Abstract

Background

The aim of the present study was to clarify both short-term and long-term results of patients with concomitant hepatocellular carcinoma (HCC) and high-risk oesophagogastric varices (OGV).

Methods

This retrospective study identified 927 cirrhotic patients who underwent curative resection of HCC between 1995 and 2012 in single institution. Patients were separated into 3 groups (A, B, and C) according to general rules for recording endoscopic findings of oesophagogastric varices proposed in Japan in 1991. Groups A, B, and C consisted of patients without OGV (F0), patients with mild to moderate OGV (F1 to F2), and patients with high-risk OGV (F3 and/or red color sign), respectively. All patients in group C underwent prophylactic endoscopic variceal ligation/sclerotherapy. Post-operative complications, mortality, overall survival, and disease-free survival were compared among 3 groups.

Results

No patient had post-operative variceal bleeding. Complication rates of Clavien-Dindo grade II to V in three groups were 13.6, 14.0, and 6.9 %, respectively (P > 0.05). Operative mortality, 5-year overall survival rate, and disease-free survival rate among the 3 groups were not significantly different (P > 0.05).

Conclusions

Prophylactic endoscopic variceal ligation/sclerotherapy effectively prevented from post-operative variceal bleeding in patients with high-risk OGV. Operative mortality, major morbidity, and survival of patients with high-risk OGV were similar to those of patients without OGV or those with mild OGV. Liver resection remains a feasible choice for cirrhotic patients with concomitant HCC and high-risk OGV.

Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379:1245–1255PubMedCrossRef

Rahbari NN, Mehrabi A, Mollberg NM et al (2011) Hepatocellular carcinoma: current management and perspectives for the future. Ann Surg 253:453–469PubMedCrossRef

Cucchetti A, Ercolani G, Vivarelli M et al (2009) Is portal hypertension a contraindication to hepatic resection? Ann Surg 250:922–928PubMedCrossRef

Santambrogio R, Kluger MD, Costa M et al (2013) Hepatic resection for hepatocellular carcinoma in patients with Child-Pugh’s A cirrhosis: is clinical evidence of portal hypertension a contraindication? HPB (Oxford) 15:78–84CrossRef

Capussotti L, Ferrero A, Vigano L et al (2006) Portal hypertension: contraindication to liver surgery? World J Surg 30:992–999. doi:10.1007/s00268-005-0524-9 PubMedCrossRef

Ishizawa T, Hasegawa K, Aoki T et al (2008) Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology 134:1908–1916PubMedCrossRef

Yao FY, Bass NM, Nikolai B et al (2002) Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transpl 8:873–883PubMedCrossRef

Llovet JM, Bru C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338PubMedCrossRef

Kawano Y, Sasaki A, Kai S et al (2008) Short- and long-term outcomes after hepatic resection for hepatocellular carcinoma with concomitant esophageal varices in patients with cirrhosis. Ann Surg Oncol 15:1670–1676PubMedCrossRef

10.

Idezuki Y (1995) General rules for recording endoscopic findings of esophagogastric varices (1991). Japanese Society for Portal Hypertension. World J Surg 19:420–422 discussion 423PubMedCrossRef

11.

Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM Classification of Malignant Tumours. Wiley-Blackwell, Oxford, pp 47–48

12.

Malinchoc M, Kamath PS, Gordon FD et al (2000) A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 31:864–871PubMedCrossRef

13.

Pugh RN, Murray-Lyon IM, Dawson JL et al (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649PubMedCrossRef

14.

Kuo MJ, Yeh HZ, Chen GH et al (2007) Improvement of tissue-adhesive obliteration of bleeding gastric varices using adjuvant hypertonic glucose injection: a prospective randomized trial. Endoscopy 39:487–491PubMedCrossRef

15.

Wu CC, Yeh DC, Lin MC et al (2001) Improving operative safety for cirrhotic liver resection. Br J Surg 88:210–215PubMedCrossRef

16.

Wu CC, Cheng SB, Ho WM et al (2004) Appraisal of concomitant splenectomy in liver resection for hepatocellular carcinoma in cirrhotic patients with hypersplenic thrombocytopenia. Surgery 136:660–668PubMedCrossRef

17.

Jeng KS, Chiang HJ (1989) Delayed formation of gallstone after transcatheter arterial embolization for hepatocellular carcinoma. Is elective cholecystectomy advisable during hepatectomy? Arch Surg 124:1319–1322PubMedCrossRef

18.

Strasberg SM, Belghiti J, Clavien P-A et al (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB (Oxford) 2:333–339

19.

Belghiti J, Noun R, Malafosse R et al (1999) Continuous versus intermittent portal triad clamping for liver resection: a controlled study. Ann Surg 229:369–375PubMedCentralPubMedCrossRef

20.

Wu CC, Yeh DC, Ho WM et al (2002) Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients: a randomized comparison of hemihepatic and total hepatic occlusion techniques. Arch Surg 137:1369–1376PubMedCrossRef

21.

Wu CC, Kang SM, Ho WM et al (1998) Prediction and limitation of hepatic tumor resection without blood transfusion in cirrhotic patients. Arch Surg 133:1007–1010PubMedCrossRef

22.

Fan ST, Lo CM, Lai EC et al (1994) Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. N Engl J Med 331:1547–1552PubMedCrossRef

23.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRef

24.

Ishizawa T, Hasegawa K, Kokudo N et al (2009) Risk factors and management of ascites after liver resection to treat hepatocellular carcinoma. Arch Surg 144:46–51PubMedCrossRef

25.

Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430PubMedCrossRef

26.

Bruix J, Castells A, Bosch J et al (1996) Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology 111:1018–1022PubMedCrossRef

27.

Nanashima A, Sumida Y, Abo T et al (2009) Treatment of concomitant gastric varices in patients with hepatocellular carcinoma at a single Japanese institute. Hepatogastroenterology 56:857–860PubMed

28.

Sugo H, Fujiwara N, Yoshimoto J et al (2008) Additional Hassab’s operation for esophagogastric varices in cirrhotic patients with resectable hepatocellular carcinoma. Hepatogastroenterology 55:1686–1690PubMed

29.

Miyazaki M, Kimura F, Shimizu H et al (2007) Surgical treatment for liver cancer. Current issues. Dig Surg 24:120–125PubMedCrossRef

30.

Beppu K, Inokuchi K, Koyanagi N et al (1981) Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc 27:213–218PubMedCrossRef

31.

Stremitzer S, Tamandl D, Kaczirek K et al (2011) Value of hepatic venous pressure gradient measurement before liver resection for hepatocellular carcinoma. Br J Surg 98:1752–1758PubMedCrossRef

32.

Zaman A, Becker T, Lapidus J et al (2001) Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Arch Intern Med 161:2564–2570PubMedCrossRef

33.

Tapper EB, Robson SC, Malik R (2013) Coagulopathy in cirrhosis: the role of the platelet in hemostasis. J Hepatol 59:889–890PubMedCrossRef

34.

Makuuchi M, Imamura H, Sugawara Y et al (2002) Progress in surgical treatment of hepatocellular carcinoma. Oncology 62(Suppl 1):74–81PubMedCrossRef

35.

Torzilli G, Belghiti J, Kokudo N et al (2013) A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC East-West study group. Ann Surg 257:929–937PubMedCrossRef

36.

Fan ST, Mau Lo C, Poon RT et al (2011) Continuous improvement of survival outcomes of resection of hepatocellular carcinoma: a 20-year experience. Ann Surg 253:745–758PubMedCrossRef

37.

Minagawa M, Ikai I, Matsuyama Y et al (2007) Staging of hepatocellular carcinoma: assessment of the Japanese TNM and AJCC/UICC TNM systems in a cohort of 13,772 patients in Japan. Ann Surg 245:909–922PubMedCentralPubMedCrossRef

38.

Poon RT, Fan ST, Lo CM et al (2002) 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 235:373–382PubMedCentralPubMedCrossRef

39.

Chok KS, Ng KK, Poon RT et al (2009) Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br J Surg 96:81–87PubMedCrossRef

40.

Fujiki M, Aucejo F, Kim R (2011) General overview of neo-adjuvant therapy for hepatocellular carcinoma before liver transplantation: necessity or option? Liver Int 31:1081–1089PubMedCrossRef

41.

Mazzaferro V, Battiston C, Perrone S et al (2004) Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective study. Ann Surg 240:900–909PubMedCentralPubMedCrossRef

42.

Graziadei IW, Sandmueller H, Waldenberger P et al (2003) Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transpl 9:557–563PubMedCrossRef

Title: Impact of Severe Oesophagogastric Varices on Liver Resection for Hepatocellular Carcinoma in Cirrhotic Patients
Authors: Hsiao-Tien Liu
Shao-Bin Cheng
Cheng-Chung Wu
Hong-Zen Yeh
Chi-Sen Chang
John Wang
Publication date: 01-02-2015
Publisher: Springer US
Published in: World Journal of Surgery / Issue 2/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2811-9

At a glance: The STEP trials

Springer Medicine

Impact of Severe Oesophagogastric Varices on Liver Resection for Hepatocellular Carcinoma in Cirrhotic Patients

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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