Electronic Journal of Liver Tumor

Current status and consideration of laparoscopic anatomical liver resection for hepatocellular carcinoma

Zheng Bowen, Zheng Shuguo

2021, 8(4): 1-5.

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Hepatectomy is one of the most effective therapeutic measures for the hepatocellular carcinoma (HCC) with high morbidity and mortality. Due to the biological characteristics of HCC metastasis through portal vein, removing both the tumor and the hepatic segment of the tumor-bearing portal territory by anatomical liver resection (AR) can effectively reduce the postoperative local recurrence and improve the long-term survival of HCC patients. In recent years, laparoscopic AR, which is widely used in the treatment of HCC, has formed a standardized operation process and achieved a double improvement in technology and concept. From the perspective of surgery and oncology, it has been proved that laparoscopic AR can bring patients both minimally invasive and survival benefits. The application of navigation techniques such as 3D visualization, laparoscopic ultrasound and indocyanine green (ICG) fusion fluorescence is more conducive to the implementation of laparoscopic AR. For HCC patients, laparoscopic AR should be the first choice if conditions permit. However, AR is not necessary for HCC patients with conditions such as severe cirrhosis, insufficient residual liver volume, large tumor and tumor located in the central region or adjacent major vessels. Both laparoscopic AR and non-anatomical liver resection (NAR) should adhere to the principle of tumor centered and margin oriented. Skillful surgical technique is the prerequisite for laparoscopic AR, while early diagnosis and comprehensive treatment remain important to improve the overall survive of patients with HCC. Laparoscopic limited AR emphasizes taking the tumor as the center and the tumor-bearing portal territory as the reference plane. It will not only maximally remove the liver tissue in the tumor-bearing portal territory, but also maximally retain the structure and volume of functional liver tissue, and it will become one of the most important methods for minimally invasive and precise treatment of HCC. Owing to the complexity of liver anatomy and the special and changeable bio-oncology behaviors of HCC, there are still some controversies and problems worthy of consideration in the treatment of HCC by laparoscopic AR.

A meta-analysis of the safety and effectiveness of laparoscopic liver resection for lesions located in posterosuperior versus anterolateral segments

Wang Yuxin, Xing Jiali, Liu Xiao, Wan Xueshuai, Zheng Yongchang, Xu Haifeng, Du Shunda, Mao Yilei

2021, 8(4): 6-12.

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Objective: To comprehensively evaluate and compare the safety and effectiveness of laparoscopic liver resection (LLR) for posterosuperior lesions versus anterolateral lesions.
Methods: A comprehensive search of literature during March 2001 and March 2021 on LLR for posterosuperior lesions versus anterolateral lesions was conducted. Literatures that met the criteria were included. Meta-analysis was performed on intraoperative outcome indicators, short-term postoperative outcome indicators and long-term outcome indicators.
Results: Compared with LLR for anterolateral lesions, the operation time was significantly longer, and conversion rate was significantly increased (P<0.0001) in LLR for posterosuperior lesions. There were no significant difference in intraoperative blood loss, intraoperative blood transfusion rate, surgical margin distance, pringle maneuver duration, postoperative hospital stay, postoperative complications (P>0.05). Among them, for patients with malignant tumors, there was no relationship between postoperative tumor-free survival as well as overall survival and tumor location (P>0.05).
Conclusion: Although LLR for lesions located in posterosuperior segments is difficult, it is a safe, effective and feasible minimally invasive surgical method that may be more beneficial to patients after the laparoscopic technique is mature.

Laparoscopic versus open liver resection for resectable multiple hepatocellular carcinomas beyond Milan criteria

Peng Yufu, Liu Fei, Li Bo, Wei Yonggang

2021, 8(4): 13-16.

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Objective: To assess the safety and efficacy of laparoscopic versus open liver resection for patients with resectable multiple hepatocellular carcinomas (HCCs) beyond Milan criteria.
Methods: A total of 217 patients met the inclusion and exclusion criteria were enrolled in this study, and there were 75 patients in the laparoscopic liver resection group (LLR) and 142 patients in the open liver resection group (OLR). 1:1 propensity score matching (PSM) was performed to calculate short- and long-term outcomes between the two groups.
Results: 72 patients with well-balanced baselines were included into each group. LLR had longer operative time (median, 237.5 min vs. 210 min, P=0.024), less intraoperative blood loss (median, 200 ml vs. 350 ml, P=0.005), less complications (P=0.035), and equivalent survival outcomes (OS, P=0.827; RFS, P=0.694) when compared with OLR.
Conclusion: LLR could be effective for some selected patients with resectable multiple HCCs beyond Milan criteria, and it had superior perioperative outcomes and similar oncological outcomes when compared with OLR.

Laparoscopic versus open mesohepatectomy for centrally located hepatocellular carcinoma: a propensity score matching study

Leng Songyao, Cao Li, Tian Feng, Wang Xiaojun, Chen Jian, Zheng Shuguo, Li Jianwei

2021, 8(4): 17-20.

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Objective: To compare open and laparoscopic mesohepatectomy for centrally located hepatocellular carcinoma by propensity score matching (PSM).
Methods: The clinical data of 130 patients with centrally located hepatocellular carcinoma treated by surgery from January 2011 to December 2017 were collected. There were 60 patients and 70 patients in the laparoscopic group and the open group all treated by anatomical mesohepatectomy (Ⅳ,Ⅴ,Ⅷ segment) and the short-term and long-term outcomes were collected.
Results: There was no significant difference in baseline data between the two groups after matching by propensity score (P>0.05). Laparoscopy was associated with lower blood loss and shorter postoperative hospital stay (P<0.05). The operation time, blood transfusion rate and complications rate were similar in open and laparoscopic groups (P>0.05). The 3 and 5-year overall survival rates and disease-free survival rates were similar in open and laparoscopic groups (P>0.05).
Conclusion: Laparoscopic anatomic hepatectomy for centrally located hepatocellular carcinoma can be carried out safely with favorable short-term and long-term outcomes.

Expression and clinical significance of paired related homoeobox-1 and cancer susceptibility candidate-2 in primary hepatic carcinoma

Li Wenchao, Zhang Dong, Zhang Dongxia

2021, 8(4): 21-25.

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Objective: To investigate the expression of paired related homoeobox-1 (PRRX1) and cancer susceptibility candidate-2 (CASC2) in primary hepatic carcinoma, and analyze their relationship with clinicopathological parameters and prognosis.
Methods: Paraffin specimens were collected from 72 patients with primary hepatic carcinoma from January 2014 to January 2017. The expressions of PRRX1 and CASC2 were detected by real-time fluorescence quantitative polymerization chain reaction (qRT-PCR), and the relationship between the expressions of PRRX1 and CASC2 and the clinicopathological parameters of primary hepatic carcinoma was analyzed. The relationship between the expression of PRRX1 and CASC2 and the prognosis of primary hepatic carcinoma patients was analyzed with death of primary hepatic carcinoma patients as the endpoint event during follow-up.
Results: The expression of PRRX1 and CASC2 in primary hepatic carcinoma tissues was lower than that in para-carcinoma tissues (P<0.05). The expression of PRRX1 was associated with vascular invasion, intrahepatic metastasis, distal metastasis and TNM stage (P<0.05). The expression of CASC2 was associated with the degree of differentiation and TNM stage (P<0.05). The results of Kaplan-Meier survival curve analysis showed that the survival rate of primary hepatic carcinoma in the low-expression group of PRRX1 and CASC2 was lower than that in the high-expression group of PRRX1 and CASC2 (P<0.05). Multivariate Cox regression analysis showed that distal metastasis, low expression of PRRX1 and CASC2 were independently correlated with poor prognosis of primary hepatic carcinoma patients (P<0.01).
Conclusions: PRRX1 and CASC2 were under expressed in primary hepatic carcinoma. Low expression of PRRX1 and CASC2 in primary hepatic carcinoma may be related to the pathogenesis and malignant progression of primary hepatic carcinoma, which can be used as an auxiliary indicator for the prognosis assessment of primary hepatic carcinoma.

Progress on clinical trials of anticancer drug for hepatocellular carcinoma in China during the 13^th Five-Year Plan Period

Yu Yue, Huang Huiyao, Wu Dawei, Wang Shuhang, Yu Anqi, Fan Qi, Bai Ying, Du Jingting, Fang Yuan, Jiang Ning, Fang Hong, Tang Yu, Li Ning

2021, 8(4): 26-30.

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Objective: To give a panoramic description of the latest research progress on clinical trials and approved products for hepatocellular carcinoma (HCC) in China in 2016-2020 (13^th Five-Year Plan Period).
Methods: Information Disclosure Platform for Drug Clinical Studies and China Food and Drug Administration Query System for Domestic and Imported Drug were searched for registered clinical trials and approved oncology drugs, respectively. The numbers and growth rates of clinical trials and approved products for hepatic carcinoma were analyzed, as well as the relevant variables. The difference between hepatic cancer and other cancers were also compared.
Results: There were 110 trials for HCC registered in China during 13^th Five-Year Plan Period, with an annual growth rate as 52%. Among them, 82 (75%) were initiated by domestic pharmaceutical enterprises. Compared with global enterprises, the proportion of phase I clinical trials and bioequivalence trials sponsored by domestic companies were higher (27% vs. 18%, 33% vs. 0, P =0.0003), while the proportion of therapeutic innovative drugs was lower (54% vs. 100%, P =0.0002). PD-1/PD-L1(19, 54%) and multi-targets of anti-angiogenesis represented by VEGFR (9, 25%) were the main investigated targets of therapeutic innovative targeted drugs. During 2016 to 2020, 6 therapeutic innovative drugs were approved in China.
Conclusions: Clinical trials on anticancer drugs of HCC in China have ushered a booming era during the 13^th Five-Year Plan Period. Local enterprises played more and more critical roles in clinical research and development. PD-1/PD-L1 and multi-targets of anti-angiogenesis are still hotspots for targeted therapy. Exploring clinical oriented anticancer drugs with novel mechanism is crucial direction of future research and development of HCC.

Progress of application of real-time virtual navigation system combined with indocyanine green staining in anatomical liver resection of primary hepatic carcinoma

Dou Xiaowei, Wang Qiang, Pu Changsheng, Shi Wenzai, Suo Xiaopeng, Wu Xianjia, Wu Tiantian, Cai Jun, Cheng Zhilei, Tian Yuanhu, Chen Jianfei, Zhang Keming

2021, 8(4): 31-35.

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The current preferred treatment for primary hepatic carcinoma is hepatectomy. However, the recurrence rate after hepatectomy is high, and the overall treatment effect is not satisfactory. The prognosis of anatomical liver resection is better than that of non-anatomical liver resection, which is gradually accepted by everyone. However, in anatomical liver resection, how to identify the tumor boundary, small intra-hepatic lesions, and the segmentation of the liver segment is still clinically facing problem. In recent years, real-time virtual navigation system (RVS) technology has been gradually applied in clinics. RVS is a complete fusion of ultrasound and CT, MRI and other imaging images. Its resolution and localization detection rate of liver cancer lesions and surrounding normal liver tissues are better than conventional intraoperative ultrasound. Indocyanine green (ICG) fluorescent staining can mark micrometastasis and liver segmentation off-line. Previous studies have shown that the use of RVS real-time dynamic navigation combined with ICG staining during surgery to eventually complete accurate anatomical liver resection can increase R0 resection rate, reduce the postoperative recurrence rate and metastasis rate of primary hepatic carcinoma, and improve primary hepatic carcinoma prognosis.

Application and progress of Yttrium-90 therapy in liver malignant tumors

Niu Huimin, Wang Zhiheng, Gao Shixin, Zeng Qian, Li Yinghui, Han Yue

2021, 8(4): 36-40.

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Liver malignant tumor includes primary liver cancer and liver metastatic cancer. Liver malignant tumor has the characteristics of high malignancy and high mortality. At present, for patients with advanced liver malignant tumors, local treatment is an important treatment method to control the progression of the disease. Yttrium-90 (⁹⁰Y) radiation microspheres are derived from the traditional transarterial chemoembolization (TACE) treatment technology and combined with the tumor short-range precision radiotherapy technology. Compared with traditional TACE treatment, ⁹⁰Y has the characteristics of high tumor response rate, low adverse response and better quality of life. This article reviews the application progress of ⁹⁰Y therapy in liver malignant tumors.

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