MDT conducted exploration for the opportunity of surgery after TACE therapy for patient with primary hepatocellular carcinoma in BCLC B stage_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MIAO Chunmu , DING Xiong , DENG Kai ,  GONG Jianping

Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding author：

GONG Jianping, Email: gongjianping11@126.com

Keywords：

primary hepatocellular carcinoma; multidisciplinary team; Barcelona Clinic Liver Cancer B stage; transarterial chemoembolization; surgical resection operation

DOI：

10.7507/1007-9424.201802054

Video：

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Objective To explore the opportunity of surgery after transarterial chemoembolization therapy for patient with primary hepatocellular carcinoma in Barcelona Clinic Liver Cancer (BCLC) B stage. Methods Multi- disciplinary team (MDT) carried out for a BCLC B stage patient in October 2017 in the Second Affiliated Hospital of Chongqing Medical University. The patient diagnosed with massive primary hepatocellular carcinoma in right lobe of the liver accompanied by para-tumor satellite nodules and metastatic nodules in quadrate lobe (BCLC B stage) in 2 months ago and received twice TACE therapies in the first 2 months. The MDT group developed anterior approach in right hepatectomy and tumor enucleation in the left medial segment. Results The experts group of MDT agreed on the patient undergone twice TACE therapies, whose tumor in right lobe had shrinked and left lobe enlarged, and the patient acquired the opportunity for surgery. By elaborately devised perioperative care and surgery risk control, the patient undergone operation successfully and recovered without any operative complications. Conclusions A proportion of BCLC B stage patients with hepatocellular carcinoma can acquire the opportunity of a second stage operation for removal of the tumor. We should manage this portion of patients well and strive for the best therapeutic effect.

Citation： MIAO Chunmu, DING Xiong, DENG Kai, GONG Jianping. MDT conducted exploration for the opportunity of surgery after TACE therapy for patient with primary hepatocellular carcinoma in BCLC B stage. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(6): 735-743. doi: 10.7507/1007-9424.201802054 Copy

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18.	陈荔, 郭金和, 朱光宇, 等. 比较香港肝癌分期和巴塞罗那肝癌分期对TACE后生存的预测作用. 介入放射学杂志, 2017, 26(12): 1088-1092.
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22.	Liu CL, Fan ST, Cheung ST, et al. Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: a prospective randomized controlled study. Ann Surg, 2006, 244(2): 194-203.
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24.	四川大学华西医院肝癌MDT团队, 文天夫. 肝细胞癌切除术后复发转移的防治: 华西医院多学科专家共识. 中国普外基础与临床杂志, 2017, 24(8): 927-939.
25.	Gao Z, Du G, Pang Y, et al. Adjuvant transarterial chemoembolization after radical resection contributed to the outcomes of hepatocellular carcinoma patients with high-risk factors. Medicine (Baltimore), 2017, 96(33): e7426.
26.	Hwang S, Lee YJ, Kim KH, et al. Long-term outcome after resection of huge hepatocellular carcinoma ≥ 10 cm: single-institution experience with 471 patients. World J Surg, 2015, 39(10): 2519-2528.
27.	陈孝平, 张万广. 肝癌切除技术创新与发展. 中华普外科手术学杂志(电子版), 2017, 11(5): 361-363.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3. El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology, 2007, 132(7): 2557-2576.
4. Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis, 1999, 19(3): 329-338.
5. 吴孟超, 汤钊猷, 刘允怡, 等. 原发性肝癌诊疗规范(2017年版). 临床肝胆病杂志, 2017, 33(8): 1419-1431.
6. Forner A, Reig ME, de Lope CR, et al. Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis, 2010, 30(1): 61-74.
7. Yin L, Li H, Li AJ, et al. Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan Criteria: a RCT. J Hepatol, 2014, 61(1): 82-88.
8. Martins-Filho SN, Paiva C, Azevedo RS, et al. Histological grading of hepatocellular carcinoma-a systematic review of literature. Front Med (Lausanne), 2017, 4: 193.
9. Huang X, Xiao Z, Zhang Y, et al. Hepatocellular carcinoma: retrospective evaluation of the correlation between gadobenate dimeglumine-enhanced magnetic resonance imaging and pathologic grade. J Comput Assist Tomogr, 2018, [Epub ahead of print].
10. Zhang L, Huang Y, Lian M, et al. Metabolic profiling of hepatitis B virus-related hepatocellular carcinoma with diverse differentiation grades. Oncol Lett, 2017, 13(3): 1204-1210.
11. Tang T, Qiu JL, Li GW, et al. Aspartate aminotransferase-to-platelet ratio predicts response to transarterial chemoembolisation and prognosis in hepatocellular carcinoma patients. Clin Radiol, 2018, 73(3): 259-265.
12. Zhu SL, Zhong JH, Ke Y, et al. Efficacy of hepatic resection vs transarterial chemoembolization for solitary huge hepatocellular carcinoma. World J Gastroenterol, 2015, 21(32): 9630-9637.
13. 刘付宝, 耿小平. 巨大肝癌外科手术治疗的抉择. 肝胆外科杂志, 2017, 25(1): 1-4.
14. Yamashita Y, Taketomi A, Shirabe K, et al. Outcomes of hepatic resection for huge hepatocellular carcinoma (≥ 10 cm in diameter). J Surg Oncol, 2011, 104(3): 292-298.
15. Min YW, Lee JH, Gwak GY, et al. Long-term survival after surgical resection for huge hepatocellular carcinoma: comparison with transarterial chemoembolization after propensity score matching. J Gastroenterol Hepatol, 2014, 29(5): 1043-1048.
16. Liang L, Xing H, Zhang H, et al. Surgical resection versus transarterial chemoembolization for BCLC intermediate stage hepatocellular carcinoma: a systematic review and meta-analysis. HPB (Oxford), 2018, 20(2): 110-119.
17. 王征, 周俭. 巴塞罗那分期挑战下的中国肝癌治疗. 肝胆外科杂志, 2014, 22(4): 241-242.
18. 陈荔, 郭金和, 朱光宇, 等. 比较香港肝癌分期和巴塞罗那肝癌分期对TACE后生存的预测作用. 介入放射学杂志, 2017, 26(12): 1088-1092.
19. Yau T, Tang VY, Yao TJ, et al. Development of Hong Kong liver cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology, 2014, 146(7): 1691-1700.
20. Chapiro J, Geschwind JF. Hepatocellular carcinoma: have we finally found the ultimate staging system for HCC? Nat Rev Gastroenterol Hepatol, 2014, 11(6): 334-336.
21. 尹新民, 朱鹏, 张万广, 等. 腹腔镜肝切除术专家共识(2013版). 中国肿瘤临床, 2013, 40(6): 303-307.
22. Liu CL, Fan ST, Cheung ST, et al. Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: a prospective randomized controlled study. Ann Surg, 2006, 244(2): 194-203.
23. 苏正, 刘波, 杨尚霖, 等. 前入路肝切除术在原发性肝癌手术中的应用价值. 中华肝脏外科手术学电子杂志, 2016, 5(1): 16-20.
24. 四川大学华西医院肝癌MDT团队, 文天夫. 肝细胞癌切除术后复发转移的防治: 华西医院多学科专家共识. 中国普外基础与临床杂志, 2017, 24(8): 927-939.
25. Gao Z, Du G, Pang Y, et al. Adjuvant transarterial chemoembolization after radical resection contributed to the outcomes of hepatocellular carcinoma patients with high-risk factors. Medicine (Baltimore), 2017, 96(33): e7426.
26. Hwang S, Lee YJ, Kim KH, et al. Long-term outcome after resection of huge hepatocellular carcinoma ≥ 10 cm: single-institution experience with 471 patients. World J Surg, 2015, 39(10): 2519-2528.
27. 陈孝平, 张万广. 肝癌切除技术创新与发展. 中华普外科手术学杂志(电子版), 2017, 11(5): 361-363.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

MDT conducted exploration for the opportunity of surgery after TACE therapy for patient with primary hepatocellular carcinoma in BCLC B stage

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