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Background and aim: The latest Barcelona Clinic Liver Cancer (BCLC) staging system suggests considering surgery in patients with resectable BCLC stage 0/A hepatocellular carcinoma (HCC) and clinically significant portal hypertension (CSPH). This study aimed to evaluate the safety and short- and long-term outcomes of laparoscopic hepatectomy for BCLC stage 0/A HCC patients with CSPH. Methods: We retrospectively reviewed the medical records of 647 HCC patients in BCLC stage 0/A who were treated at five centers between January 2010 and January 2019. Among these patients, 434 underwent laparoscopic hepatectomy, and 213 underwent open hepatectomy. We used Kaplan–Meier analysis to compare the overall survival (OS) rate and recurrence-free survival (RFS) rate between patients with and without CSPH before and after propensity score matching (PSM). Multivariate Cox regression analysis was performed to identify prognostic factors for BCLC stage 0/A patients, and subgroup analyses were also conducted. Results: Among the 434 patients who underwent laparoscopic hepatectomy, 186 had CSPH and 248 did not. The Kaplan–Meier analysis showed that the OS and RFS rates were significantly worse in the CSPH group before and after PSM. Multivariate Cox regression analyses identified CSPH as a prognostic factor for poor OS and RFS after laparoscopic hepatectomy. However, CSPH patients treated laparoscopically had a better short- and long-term prognosis than those treated with open surgery. Conclusions: CSPH has a negative impact on the prognosis of BCLC stage 0/A HCC patients after laparoscopic hepatectomy. Laparoscopic hepatectomy is still recommended for treatment, but careful patient selection is essential. [ABSTRACT FROM AUTHOR]

Background and Aim: Clinical work has revealed that hepatectomy for resectable ruptured hepatocellular carcinoma (rHCC) has a relatively high percentage of positive resection margins found in postoperative pathology. It is necessary to evaluate the risk factors associated with R1 resection in patients undergoing hepatectomy for rHCC. Methods: A total of 408 patients with resectable rHCC originating from three centers undergoing surgery from January 2012 to January 2020 were consecutively enrolled in the study to study the prognostic impact of R1 resection using Kaplan–Meier plotting of survival curves. One center with 280 served as the training group, and the other two centers served as the validation group. Multivariate logistic regression analysis screened for variables affecting R1 and developed prediction models, and the models were tested in the validation cohort using the receiver operating characteristic curves (ROC) and calibration curves. Results: The prognosis of rHCC patients with positive cut margins was worse than that of patients with R0 resection. Risk factors for R1 resection were tumor max length (OR = 2.668 [1.161–6.131]), microvascular invasion (MVI) (OR = 3.655 [1.766–7.566]), times of hepatic inflow occlusion (1/0:OR = 2.213 [1.113–4.399]; 2/0:OR = 5.723 [2.010–8.289]) and timing of hepatectomy (OR = 5.284 [2.394–9.661]), using tumor max length, times of HIO, and timing of hepatectomy to construct the nomogram, the area under the curve of the model was 0.810 (0.781–0.842) and 0.782 (0.752–0.805) in the training and validation groups, respectively, and the calibration curve of the model was basically on the 45° line. Conclusions: This study constructs a clinical model to predict R1 resection after hepatectomy for resectable rHCC, which can be used to better plan perioperative strategies for the incidence of R1 resection during hepatectomy. [ABSTRACT FROM AUTHOR]

Background: At present, the choice of treatment modalities for ruptured hepatocellular carcinoma patients in BCLC stage A remains controversial, and this study compared the overall survival of ruptured HCC patients undergoing TACE or hepatectomy. Methods: A total of 283 ruptured HCC patients treated at our liver surgery center were included in our study, of which 175 were treated with hepatectomy and 108 were treated with TACE. To reduce selection bias, we used a propensity score matching (PSM) model, which yielded a total of 88 pairs of patients. We used the Kaplan–Meier method to compare the long-term prognosis, and the Landmark method was used to compare the short-term and long-term prognoses of patients after PSM. Finally, we performed subgroup analysis according to whether it met the Milan criteria. Results: After PSM, in the hepatectomy group, the 1-, 3-, and 5 year OS rates were 73.4%, 45.4%, and 33.9%, respectively. In the TACE group, the 1-, 3-, and 5 year OS rates were 58.5%, 40.6%, and 23.2%, respectively. Within one year, the hepatectomy group had a better prognosis than the TACE group (P = 0.022), but there was no difference in long-term survival(P = 0.936). In the subgroup analysis, in patients who met the Milan criteria, the survival curve indicated that there was no statistically significant difference in the survival prognosis between the two groups (P = 0.294) HR = 1.56(0.68–3.59); in the patients beyond the Milan criteria, the survival time was 28.0 months (20.0–34.0) in patients who underwent hepatectomy and 18 months (9.8–26.2) in patients who underwent TACE, and the survival curve indicated a statistically significant difference (P = 0.043) HR = 1.57(1.01–2.43). Conclusion: Our propensity score-matched study found that ruptured HCC patients treated by hepatectomy had a better short-term prognosis than those treated by TACE, but there was no difference in the long-term prognosis between the two treatment groups. [ABSTRACT FROM AUTHOR]

Background. This research is aimed at establishing a scoring system alpha-fetoprotein+alkaline phosphatase (A-A score) based on preoperative serum alpha-fetoprotein (AFP) and alkaline phosphatase (ALP) levels and to investigate its clinical significance in patients with ruptured hepatocellular carcinoma (rHCC) after hepatectomy. Methods. 175 ruptured hepatocellular carcinoma (HCC) patients treated with hepatectomy were included. Survival analysis was assessed by the Kaplan-Meier method. Prognostic factors were analyzed in a multivariate model. Preoperative serum AFP and ALP values are assigned a score of 1 if they exceed the threshold value and 0 if they are below the threshold value, A-A score is obtained by summing the scores of two variables (AFP, ALP), and the predictive values of AFP, ALP, and A-A score were compared by receiver operating characteristic curve (ROC) analysis, and subgroup analyses were performed to further evaluate the power of A-A scores. Results. Of the 175 patients, 67 (38.3%) had an A-A score of 0, 72 (41.1%) had an A-A score of 1, and 36 (20.6%) had an A-A score of 2. In multivariate analysis, the A-A score, the BCLC stage, and the extent of resection were independent predictors of OS in patients with rHCC. The 1-, 3-, and 5-year OS and RFS in patients with an A-A score of 1 were better than those with an A-A score of 0 and worse than those with an A-A score of 1 (all p < 0.05). Based on the results of ROC analysis, the A-A score is superior to AFP or ALP alone in predicting the prognosis of patients with ruptured HCC. In subgroup analysis, A-A score could accurately predict the prognosis of patients with or without microvascular invasion (MVI) and with different Child-Pugh grades or gender. Conclusions. The A-A score can effectively predict the prognosis of patients after hepatectomy of ruptured hepatocellular carcinoma. At the same time, it also has good evaluation ability in different subgroups. [ABSTRACT FROM AUTHOR]

Objectives: Large hepatocellular carcinoma (LHCC) is prone to short‐term recurrence and poor long‐term survival after hepatectomy, and there is still a lack of effective neoadjuvant treatments to improve recurrence‐free survival (RFS) and overall survival (OS). We retrospectively analyzed the efficacy of preoperative transcatheter arterial chemoembolization (TACE) in solitary LHCC (≥5 cm). Materials and Methods: A multicenter medical database was used to analyze preoperative TACE's effects on RFS, OS, and perioperative complications in patients with solitary LHCC who received surgical treatment from January 2005 to December 2015. The patients were divided into Group A (5.0–9.9 cm) and Group B (≥10 cm), with 10 cm as the critical value, and the effect of preoperative TACE on RFS, OS and perioperative complications was assessed in each subgroup. Results: In the overall population, patients with preoperative TACE had better RFS and OS than those without preoperative TACE. However, after stratifying the patients into the two HCC groups, preoperative TACE only improved the survival outcomes of patients with Group B (≥10 cm). Multivariate Cox‐regression analysis showed that lack of preoperative TACE was an independent risk factor for RFS and OS in the overall population and in Group B but not in Group A. Conclusions: Preoperative TACE is beneficial for patients with solitary HCC (≥10 cm). [ABSTRACT FROM AUTHOR]

Background: Liver resection offers a chance of cure for patients with hepatocellular carcinoma (HCC). Hepatic pedicle clamping (HPC) is commonly used to reduce blood loss during hepatectomy. Hepatic ischemia-reperfusion (I/R) injury has recently been reported to be a major factor in accelerated tumor growth. We therefore evaluated the effect of intermittent HPC on the prognosis of patients after liver resection. Methods: The clinicopathological features and serum/tissue samples of 386 HCC patients who underwent curative liver resection were prospectively collected. The patients were divided into the HPC group (over 30 min) and the non-HPC group. Disease-free survival and overall survival were analyzed using multivariate analyses, Kaplan-Meier curves, and log-rank tests. Matrix metalloproteinases and E-selectin were measured to study hepatic I/R injury. Results: The preoperative clinicopathological data were comparable between the HPC group ( n = 224) and the non-HPC group ( n = 162). During the study period, 257 of the 386 patients (66.6 %) developed tumor recurrence. The overall tumor recurrence and intrahepatic tumor recurrence rates were not significantly different between the two groups. There were no significant differences between the two groups with respect to the 1-, 3-, and 5-year disease-free and overall survival rates. Similarly, subgroup analyses also showed no marked difference in survival rates for patients with cirrhosis in the two groups. The levels of mRNA in liver tissues and serum concentrations of MMP-2, MMP-9, and E-selectin showed no significant differences between the pre- and post-occlusion periods. Conclusions: Intermittent HPC produced no adverse effect on disease-free and overall survival for patients who underwent liver resection for HCC. [ABSTRACT FROM AUTHOR]

The purpose of the study is to evaluate the protective effects of Verapamil on hepatic ischemia–reperfusion injury in cirrhotic patients with HCC. A controlled study was performed on 86 consecutive patients with cirrhosis who underwent liver resection for suffering HCC. Thirty-nine patients were injected with Verapamil through the mesenteric vein before Pringle's maneuver to alleviate hepatic ischemia–reperfusion injury, while 47 patients were not. The serum AST, ALT, and total bilirubin on days 1 and 3 were markedly lower in the Verapamil group than that in the control group postoperatively (AST, P < 0.001 and P < 0.001; ALT, P < 0.001 and P = 0.042; TB, P = 0.037 and 0.049; respectively). The serum hyluronic acid on day 1 was also significantly lower in Verapamil group than that in the control group ( P < 0.01), but no marked difference on days 3 and 7. Meanwhile, the levels of IL6 on days 1 and 3 were markedly lower in the Verapamil group than that in control group ( P < 0.05 and P < 0.01, respectively. The new Clavien's classification of surgical complications showed marked severity in the control group than that in the Verapamil group ( P = 0.021), especially in the grade I level ( P = 0.045). Verapamil may serve as protective agent for hepatic ischemia–reperfusion injury in cirrhotic patients with HCC. Therefore, Verapamil can be used for treatment of patients who are to undergo hepatectomy with occlusion of hepatic blood flow. [ABSTRACT FROM AUTHOR]

Simple Summary: The liver function reserve of patients with hepatocellular carcinoma (HCC) is heterogeneous. The preoperative accurate evaluation of liver function has a vital role in the prevention of unfavorable postoperative complications such as post-hepatectomy liver failure. In this study, unsupervised clustering analysis of radiomics features extracted from preoperative gadoxetic-acid-enhanced MRIs was performed for liver function stratification on 276 HCC patients. Two distinct subgroups were identified (i.e., subgroups 1 and 2). Subgroup 2 had impaired liver function as presented by older age, more albumin–bilirubin grades 2 and 3, and a higher indocyanine green retention rate than that of subgroup 1 (all p < 0.05). Compared with subgroup 1, subgroup 2 was associated with a higher risk of postoperative liver failure, postoperative complications, and longer hospital stays (all p < 0.05). Our findings indicate the potential for the use of radiomics features based on preoperative gadoxetic-acid-enhanced MRI for noninvasive liver function assessment in HCC patients. Objective: To identify subgroups of patients with hepatocellular carcinoma (HCC) with different liver function reserves using an unsupervised machine-learning approach on the radiomics features from preoperative gadoxetic-acid-enhanced MRIs and to evaluate their association with the risk of post-hepatectomy liver failure (PHLF). Methods: Clinical data from 276 consecutive HCC patients who underwent liver resections between January 2017 and March 2019 were retrospectively collected. Radiomics features were extracted from the non-tumorous liver tissue at the gadoxetic-acid-enhanced hepatobiliary phase MRI. The reproducible and non-redundant features were selected for consensus clustering analysis to detect distinct subgroups. After that, clinical variables were compared between the identified subgroups to evaluate the clustering efficacy. The liver function reserve of the subgroups was compared and the correlations between the subgroups and PHLF, postoperative complications, and length of hospital stay were evaluated. Results: A total of 107 radiomics features were extracted and 37 were selected for unsupervised clustering analysis, which identified two distinct subgroups (138 patients in each subgroup). Compared with subgroup 1, subgroup 2 had significantly more patients with older age, albumin–bilirubin grades 2 and 3, a higher indocyanine green retention rate, and a lower indocyanine green plasma disappearance rate (all p < 0.05). Subgroup 2 was also associated with a higher risk of PHLF, postoperative complications, and longer hospital stays (>18 days) than that of subgroup 1, with an odds ratio of 2.83 (95% CI: 1.58–5.23), 2.41(95% CI: 1.15–5.35), and 2.14 (95% CI: 1.32–3.47), respectively. The odds ratio of our method was similar to the albumin–bilirubin grade for postoperative complications and length of hospital stay (2.41 vs. 2.29 and 2.14 vs. 2.16, respectively), but was inferior for PHLF (2.83 vs. 4.55). Conclusions: Based on the radiomics features of gadoxetic-acid-enhanced MRI, unsupervised clustering analysis identified two distinct subgroups with different liver function reserves and risks of PHLF in HCC patients. Future studies are required to validate our findings. [ABSTRACT FROM AUTHOR]

Background: There is currently no clear consensus on the relative suitabilities of laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) as minimally invasive treatment for small hepatocellular carcinoma (HCC).Methods: In this retrospective study, we enrolled 156 patients with a single, small HCC with nodular diameters <4 cm and compared recurrence-free survival (RFS) and overall survival (OS) between patients treated with LH and control patients treated with RFA (n = 78 each). The groups were selected according to predefined criteria and matched in terms of their baseline clinical characteristics.Results: During a median follow-up of 31.2 months, the 1-, 2-, and 3-year OS rates in the LH group were 96.2, 91.3, and 84.1 %, respectively, compared with 96.2, 82.6, and 78.8 % in the RFA group. The corresponding RFS rates were 82.1, 71.5, and 60.0 % in the LH group and 65.4, 47.7, and 37.6 % in the RFA group. Combined RFS rates were significantly higher in the LH groups (P = 0.006), but there was no significant difference in OS rates (P = 0.510). The incidence of postoperative complications was significantly lower in the RFA group (28.2 vs. 10.3 %, P = 0.004), and operation duration, intraoperative blood loss and blood transfusion, use of total parenteral nutrition, and length of stay as indicators of minimal invasiveness were also significantly better in the RFA group.Conclusions: There was no difference between LH and RFA in terms of OS in patients with a single, small HCC. However, RFA was less invasive than the LH, but LH was associated with increased RFS. [ABSTRACT FROM AUTHOR]

Background & Aims: The aim of this study was to compare the efficacy of radiofrequency ablation (RFA) with surgical resection (RES) in the treatment of small hepatocellular carcinoma (HCC). Methods: A total of 168 patients with small HCC with nodular diameters of less than 4cm and up to two nodules were randomly divided into RES (n=84) and RFA groups (n=84). Outcomes were carefully monitored and evaluated during the 3-year follow-up period. Results: The 1-, 2-, and 3-year survival rates for the RES and RFA groups were 96.0%, 87.6%, 74.8% and 93.1%, 83.1%, 67.2%, respectively. The corresponding recurrence-free survival rates for the two groups were 90.6%, 76.7%, 61.1% and 86.2%, 66.6%, 49.6%, respectively. There were no statistically significant differences between the two groups in overall survival rate (p =0.342) or recurrence-free survival rate (p =0.122). Multivariate analysis demonstrated that the independent risk factors associated with survival were multiple occurrences of tumors at different hepatic locations (relative risk of 2.696; 95% CI: 1.189–6.117; p =0.018) and preoperative indocyanine green retention rate at 15min (ICG-15) (relative risk of 3.853; 95% CI: 1.647–9.015; p =0.002). Conclusions: In patients with small hepatocellular carcinomas, percutaneous RFA may provide therapeutic effects similar to those of RES. However, percutaneous RFA is more likely to be incomplete for the treatment of small HCCs located at specific sites of the liver, and open or laparoscopic surgery may be the better choice. [Copyright &y& Elsevier]