ObjectiveTo explore the value of radiofrequency ablation (RFA) in the radical cure for hepatocellular carcinoma (HCC). MethodThe recent literatures about RFA in the treatment for HCC were retrieved and reviewed. ResultsThe liver transplantation, liver resection, and RFA were the three effective treatments in curative intent for early HCC.RFA was more frequently used in downsize therapy prior to liver transplantation in recent years because of its excellent local tumor control.Preoperative RFA extended the average waiting time without increasing the risk of dropout.Even though the controversy about effectiveness of RFA and hepatectomy was not been settled, the liver resection com-bined with RFA extended the operation indication of HCC and improved the effectiveness. ConclusionsRFA plays more and more important roles among the various treatment strategies in HCC.RFA, liver transplantation, and hepatectomy could be complementary to each other in the treatment for HCC and benefit numerous patients.Among these strategies, the key to improve the effectiveness is that minimum reduces residual tumors and suppresses their growth.
ObjectiveTo analyze impact of body mass index (BMI) on postoperative complications and disease-free survival (DFS) after hepatectomy for patients with hepatocellular carcinoma (HCC). MethodsIn total, 858 patients with HCC underwent hepatectomy were analyzed by retrospective cohort study. Patients were divided into two groups according to BMI:normal group (18.5 kg/m2 < BMI < 25.0 kg/m2) and obesity group (BMI≥25.0 kg/m2). The clinical and postoperative follow-up data were collected and statistically analyzed. Results① Compared with the normal group, the preoperative HBV-DNA loading was significantly lower (P<0.05), albumin was significantly higher (P<0.05), intraopera-tive blood loss was significantly increased (P<0.05), operation time, and the first portal hepatis occlusion time were signifi-cantly prolonged (P<0.05) in the obesity group. The postoperative complications and hospital stay had no significant differences between these two groups (P>0.05). ② The results of univariate analysis showed that the preoperative HBV-DNA≥ 104 U/mL, total bilirubin >21 μmol/L, albumin <35 g/L, grade B of Child-Pugh, intraoperative blood loss >500 mL, and operation time >240 min were associated with the postoperative complications after hepatectomy for patients with HCC (P<0.05). The results of multivariate analysis showed that preoperative total bilirubin >21 μmol/L, albumin <35 g/L, and operation time >240 min were the independent risk factors for postoperative complications (P<0.05). ③ Kaplan-Meier analysis showed that the 3-year DFS in the obesity group was significantly better than that in the normal group (P<0.05). The results of multivariate analysis showed that the major blood vessel tumor thrombi, multicenter tumor, tumor diameter ≥5 cm, and operation time >240 min were the independent risk factors for DFS (P<0.05), while the obesity was the protective factor for DFS (P<0.05). ConclusionFor HCC patients who receiving hepatectomy, obesity does not increase risk of postoperative complications, and could increase 3-year DFS. Thus preoperative improvement of nutritional status of patient with HCC has a great significance.
ObjectiveTo evaluate whether radiofrequency-assisted associating liver partition and portal vein ligation for staged hepatectomy (RALPPS) is a safer and more effective modified treatment for patients with cirrhosis-related hepatocellular carcinoma (HCC). MethodsRALPPS were performed in patients with HCC and insufficient volume of future liver remnant (FLR<40%). Data of the patients during perioperative period such as operative morbidity, mortality, operative time, blood loss, percent increase in FLR, and interval between operations, were analyzed to assess the effectiveness and safety of the operation. ResultsA total of 8 patients were performed the RALPPS operation, and 6 cases completed both stages, 2 cases of postoperative complications or tumor metastasis did not complete the two phase of surgery. The average first and second stages operative time was (214.3±35.7) min, (266.7±46.0) min, respectively, and the average two stages blood loss during the operation was (218.8±113.2) mL,(501.7±224.5) mL, respectively. The mean preoperative FLR was (26.4±7.1)%, and the mean FLR before the second stage was (46.2±4.6)%. The average percentage increase in FLR during the interval time was 35%-113%, and the mean time interval between operations were (22.2±6.4) days. One case died of renal failure and severe pulmonary infection after two operation. Seven patients were followed-up (11.6+2.0) months (8-15 months). Two patients who had not completed the two-stage operation died within 3 months after discharge. Three patients who had completed the two-stage operation were tumor recurrence in 3-9 months after discharged from hospital and supplemented interventional therapy, 1 of them died,and 2 patients were followed-up to now without recurrence. ConclusionsRALPPS is equivalent to ALPPS for treating patients with cirrhosis-related HCC and insufficient FLR volume.