Technical advancement, accurate preoperative diagnosis, understanding of hepatic architecture and function, and enhanced anesthetic support have expanded the indications of hepatic resection while lowering perioperative morbidity and mortality. Especially in cases of infiltration of retrohepatic vena cava by tumor, aggressive hepatic resection involving the inferior vena cava( IVC ) has become safe and feasible using total vascular isolation(TVI) with veno-venous bypass and patch grafting. Authors reported a case of curative resection for hepatocellular carcinoma invading the inferior vena cava using TVI with veno-venous bypass and saphenous vein patch graft
Carcinoma, Hepatocellular ; Diagnosis ; Mortality ; Saphenous Vein* ; Transplants* ; Vena Cava, Inferior*

PURPOSE: Most liver surgeons perform a right hepatic resection for a hepatocellular carcinoma (HCC) for the complete mobilization of the right lobe of liver, via the conventional approach, prior to a parenchymal transection. However, in selected patients, with a massive hepatoma that has invaded to the diaphragm, the conventional mobilization of the liver prior to a parenchymal transection may be very difficult and result in excessive bleeding. The feasibility of an 'anterior approach' was evaluated by analyzing of the clinical result of the surgical treatment for a massive hepatoma with diaphragmatic invasion. METHODS: Between November, 2001 and November, 2002, six patients underwent a major right hepatic resection, using an anterior approach, for a HCC that had invaded or was adhered to the diaphragm, preventing the easy mobilization of the right lobe of the liver. RESULTS: There was no hospital mortality among six patients. A massive transfusion, followed by massive bleeding, was performed in four patients, but no post-operative liver failure occurred. CONCLUSION: These cases, performed via an anterior approach, had massive bleeding, but no hospital mortality or post- operative liver failure was observed. If the patients had undergone the procedure via the conventional approach, much more bleeding would have been expected. An 'anterior approach' is a safe and effective option in selected patients with a massive hepatoma and diaphragmatic invasion.
Carcinoma, Hepatocellular* ; Diaphragm ; Hemorrhage ; Hospital Mortality ; Humans ; Liver ; Liver Failure

BACKGROUND/AIMS: Programmed death receptor 1 (PD-1) is a promising new target for treatment of patients with hepatocellular carcinoma (HCC). A high expression level of programmed death-ligand 1 (PD-L1) is a possible prognostic indicator for poor outcome in other malignancies. Here, we investigated the clinical significance of PD-1 and PD-L1 in patients with HCC. METHODS: We enrolled patients with HCC who underwent surgical resection at Severance Hospital between 2012 and 2017 and investigated the levels of PD-L1 in HCC tissues (tPD-L1) and PD-L1/PD-1 in serum (sPD-L1/sPD-1). We also aimed to determine whether expression levels correlated with clinical and histological features. RESULTS: A total of 72 patient samples were analyzed. The median sPD-L1 and sPD-1 levels were 25.72 and 341.44 pg/mL, respectively. A positive correlation was detected between tPD-L1 and sPD-1 levels (R²=0.426, P<0.001). The median sPD-1 level increased linearly with tPD-L1 score (P=0.002). During the follow-up period, HCC recurred in eight (11.1%) patients and liver-related mortality occurred in eight (11.1%) patients. Higher sPD-L1 levels (≥19.18 pg/mL) tended to be associated with liver-related mortality (hazard ratio 6.866; 95% confidence interval, 0.804–58.659, P=0.078). sPD-1 levels of patients treated with nivolumab as a second-line therapy changed serially, and a >50% reduction in sPD-1 levels was observed immediately after nivolumab administration. However, sPD-1 level was not associated directly with prognosis in patients with advanced HCC. CONCLUSIONS: The results demonstrated that PD-L1 and PD-1 levels changed according to the immunotherapy. However, no significant association with clinical outcome in patients with HCC was detected.
Carcinoma, Hepatocellular ; Follow-Up Studies ; Humans ; Immunotherapy ; Mortality ; Prognosis

No abstract available.
Carcinoma, Hepatocellular/*epidemiology/mortality ; Female ; Humans ; Incidence ; Korea/epidemiology ; Liver Neoplasms/*epidemiology/mortality ; Male ; Survival Rate

OBJECTIVETo establish a reasonable protocol for interventional treatment of hepatocellular carcinoma (HCC).

METHODSThe data of 1 000 HCC patients treated by different kinds of interventional treatment were reviewed with their results of biochemistry, imaging, pathology and survival rate evaluated. The value as well as the pros and cons of these various kinds of interventional treatment were compared in order to find an optimum protocol.

RESULTSSegmental-transcatheter oil chemoembolization (S-TOCE) was much effective eradicate the tumor yet inflicting less damage on the noncancerous hepatic tissue and giving much higher survival rate than the conventional transcatheter oil chemoembolization (C-TOCE). Percutaneous ethanol injection (PEI) played an important role in eradicating the residual tumor and improving the survival rate without damaging the noncancerous hepatic tissue. The survival quality or survival rate could be improved by choosing different ways of interventional treatments to cut down the complications.

CONCLUSIONThe selection of different interventional treatments should be done according to the size and type of HCC. Active management is indicated for different complications presenting along with HCC.

Carcinoma, Hepatocellular ; mortality ; therapy ; Chemoembolization, Therapeutic ; Humans ; Liver Neoplasms ; mortality ; therapy ; Retrospective Studies ; Survival Rate

OBJECTIVETo investigate the mortality rates of hepatocellular carcinoma (HCC) in Nantong,China from 1999 to 2011, in order to uncover dynamic trends and provide reasoned advice on intervention strategies to decrease HCC incidence and mortality in Nantong in the future.

METHODSVersions 10 and 9 of the WHO International Classification of Diseases (ICD-10 and ICD-9) were used to determine the number of HCC deaths in Nantong,China for the study's range of years. Thex2 test was applied to compare the HCC mortality rates according to sex and age. The Grey system GM(1,1) model was used to predict the next-5-year HCC mortality for Nantong.

RESULTSAnalysis of the standardized mortality in Nantong showed a slight decreasing trend from 1999 to 2011 (x2=57 545.98, P less than 0.001),with males showing a steeper decrease than females. The total mortality of HCC during these years was 53.41 per 100,000 people,with mortality among males being significantly higher than that among females (80.81 per 100,000 people vs. 26.94 per 100,000 people; x2=13 625.42, P less than 0.001). In general, HCC mortality increased with increase in age (general trend:x2=57 545.98, P less than 0.001; male trend: x2=39 878.8, P less than 0.001; female trend: x2=20 105.3, P less than 0.001). However,HCC mortality increased significantly in women after the age of 40 and in men after the age of 35. The GM(1,1) equation was: Yt=-1265.28e(-0.0375t)+1315.5, which predicted that the HCC mortality will decrease to 25.56 per 100,000 people in 2016.

CONCLUSIONAlthough HCC mortality generally decreased from 1999 to 2011, the rate remained high. Public health intervention strategies may be more effective if they focus on males over the age of 35 and females over the age of 40.

Carcinoma, Hepatocellular ; mortality ; China ; epidemiology ; Female ; Humans ; Incidence ; Liver Neoplasms ; mortality ; Male

To explore the feasibility and efficacy of isolated caudate lobe resection for caudate lobe in huge hepatocellular carcinoma(10 cm or larger in diameter).
 Methods: Clinical data of 27 patients with hepatocellular carcinoma larger than 10 cm who underwent isolated caudate lobe resection from January 2001 to December 2011 were retrospectively analyzed.
 Results: All the patients successfully completed the operation. There was no postoperative death. Median operative time was 288 min, and the estimated intraoperative blood loss was 2 260 mL. Postoperative morbidity rate was 44.4%. The patients were discharged successfully after active treatment. Overall survival rates at 1, 3, and 5 years were 80.2%, 52.1%, and 27.1%, respectively.
 Conclusion: Isolated caudate lobe resection is safe and effective for caudate lobe huge hepatocellular carcinoma.
Carcinoma, Hepatocellular ; mortality ; surgery ; Hepatectomy ; Humans ; Liver Neoplasms ; mortality ; surgery ; Retrospective Studies ; Survival Analysis ; Treatment Outcome

Liver cancer is one of the leading causes of cancer-related death in Korea. Liver cancer imposes a considerable societal burden due to its high incidence and high mortality rate in younger patients, as compared to other cancers. However, interest in liver cancer among researchers and health-policy makers is low. In this review, recent trends in the number of published articles on liver cancer in Korea and internationally were analyzed. The key finding is that the rate of growth in the number of published articles on liver cancer is slowly decreasing and financial investment for research into liver cancer is very limited, despite the increasing research and development investment budget in Korea. Meanwhile, the rate of growth of research into liver cancer in China has recently increased markedly. Therefore, the scale and rate of growth of research into liver cancer in Korea should be enhanced.
Budgets ; Carcinoma, Hepatocellular ; China ; Humans ; Incidence ; Investments ; Korea* ; Liver Neoplasms* ; Liver* ; Mortality

Although surgical resection can provide best treatment outcome with curative intent, patients with relatively early stage of hepatocellular carcinoma (HCC) can get benefit of this treatment. Barcelona Clinic Liver Cancer (BCLC) staging system limits surgical resection to patients with single HCC with well-preserved liver function, which is often challenged in real practice, especially from Asian countries. During last two decades, surgical outcomes have made remarkable progress approaching zero mortality in many reports. In this review, areas that surgical indications can be expanded beyond BCLC staging system will be discussed, especially in Asian population.
Asian Continental Ancestry Group ; Carcinoma, Hepatocellular* ; Humans ; Liver Neoplasms* ; Liver* ; Mortality ; Treatment Outcome

BACKGROUND/AIMS: We investigated the outcomes of early-stage hepatocellular carcinoma (HCC) patients who showed a complete response (CR) to initial transarterial chemoembolization (TACE), with a focus on the role of scheduled TACE repetition. METHODS: A total of 178 patients with early-stage HCC who were initially treated with TACE and showed a CR based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria on one month follow-up computed tomography (CT) were analyzed. Among them, 90 patients underwent scheduled repetition of TACE in the absence of viable tumor on CT. RESULTS: During a median follow-up period of 4.6 years (range: 0.4-8.8 years), mortality was observed in 71 patients (39.9%). The overall recurrence-free and local recurrence-free survival rates at 1 year were 44.4% and 56.2%. In the multivariable model, scheduled repetition of TACE was an independent factor associated with survival (hazard ratio [95% confidence interval]: 0.56 [0.34-0.93], P=0.025). When stratified using Barcelona clinic liver cancer (BCLC) stage, scheduled repetition of TACE was associated with a favorable survival rate in BCLC stage A patients, but not in BCLC 0 patients. CONCLUSIONS: Scheduled repetition of TACE was associated with better survival for early-stage HCC patients showing a CR after initial TACE, especially in BCLC stage A patients.
Carcinoma, Hepatocellular* ; Follow-Up Studies ; Humans ; Liver Neoplasms ; Mortality ; Response Evaluation Criteria in Solid Tumors ; Survival Rate