Liver resection for hepatocellular carcinoma beyond the BCLC: are multinodular disease, portal hypertension, and portal system invasion real contraindications?

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorBARROS, A. Z. de Almeida
dc.contributor.authorFONSECA, G. M.
dc.contributor.authorKRUGER, J. A. P.
dc.contributor.authorCOELHO, F. F.
dc.contributor.authorHERMAN, P.
dc.date.accessioned2024-03-13T19:54:23Z
dc.date.available2024-03-13T19:54:23Z
dc.date.issued2022
dc.description.abstractBackground: Barcelona Clinic Liver Cancer (BCLC) is a recognized guideline to standardize treatment allocation for hepatocellular carcinoma (HCC); however, many centers criticize its restrictive liver resection recommendations and have published good results after more liberal hepatectomy indications. The objective is to evaluate the results of HCC resection in a single center, with a more liberal indication for resection than proposed by the BCLC guideline. It was performed a retrospective cohort study including all patients who underwent liver resection for HCC in a single center between April 2008 and November 2018. Methods: The results of 150 patients who underwent hepatectomy were evaluated and compared facing both 2010 and 2018 BCLC guidelines. Overall and disease-free survival after resection in patients with none, one, two, or three of the risk factors, as proposed by the BCLC, as contraindications to resection (portal hypertension, portal invasion, and more than one nodule) were analyzed. Results: Nodule size and presence of portal invasion alone did not affect prognosis. If the BCLC 2010 and 2018 guidelines were followed, 46.7% and 26.7% of the patients, respectively, would not have received potentially curative treatment. The median overall and disease-free survival for patients with one BCLC contraindication factor were 43.3 and 15.1 months, respectively. The presence of two risk factors had a negative impact on overall survival (OS) and disease-free survival (DFS), although some patients had long-term survival. The only patient with the three risk factors had a poor outcome. Conclusions: Selected patients with one BCLC contraindication factor may undergo resection with good results, whereas those with two factors should be allocated for hepatectomy only in favorable scenarios. Patients with the three risk factors do not appear to benefit from resection.eng
dc.description.indexPubMed
dc.description.indexScopus
dc.description.indexDimensions
dc.description.indexDimensions
dc.description.indexWoS
dc.identifier.citationJOURNAL OF GASTROINTESTINAL ONCOLOGY, v.13, n.6, p.3123-3134, 2022
dc.identifier.doi10.21037/jgo-22-833
dc.identifier.issn2078-6891
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/58623
dc.language.isoeng
dc.publisherAME PUBLISHING COMPANYeng
dc.relation.ispartofJournal of Gastrointestinal Oncology
dc.rightsopenAccesseng
dc.rights.holderCopyright AME PUBLISHING COMPANYeng
dc.subjectBarcelona Clinic Liver Cancer guideline (BCLC guideline)eng
dc.subjecthepatectomyeng
dc.subjectHepatocellular carcinoma (HCC)eng
dc.subjectliver resectioneng
dc.subjecttreatmenteng
dc.subject.otheralpha fetoproteineng
dc.subject.otherantineoplastic agenteng
dc.subject.otheradulteng
dc.subject.otheragedeng
dc.subject.otheralcohol liver diseaseeng
dc.subject.otheralpha fetoprotein blood leveleng
dc.subject.otherarticleeng
dc.subject.otherasciteseng
dc.subject.otherbile duct fistulaeng
dc.subject.othercancer palliative therapyeng
dc.subject.othercancer patienteng
dc.subject.othercancer prognosiseng
dc.subject.othercancer surgeryeng
dc.subject.othercancer survivaleng
dc.subject.otherchemoembolizationeng
dc.subject.otherchronic liver diseaseeng
dc.subject.otherclinical outcomeeng
dc.subject.othercohort analysiseng
dc.subject.othercontrolled studyeng
dc.subject.otherdisease free survivaleng
dc.subject.otherfemaleeng
dc.subject.otherfollow upeng
dc.subject.otherheart infarctioneng
dc.subject.otherhepatectomyeng
dc.subject.otherhepatitis beng
dc.subject.otherhepatitis ceng
dc.subject.otherhumaneng
dc.subject.otherhypovolemic shockeng
dc.subject.otherliver cell carcinomaeng
dc.subject.otherliver transplantationeng
dc.subject.otherlong term survivaleng
dc.subject.othermajor clinical studyeng
dc.subject.othermaleeng
dc.subject.othernonalcoholic steatohepatitiseng
dc.subject.otheroverall survivaleng
dc.subject.otherperitonitiseng
dc.subject.otherpneumoniaeng
dc.subject.otherportal hypertensioneng
dc.subject.otherportal systemeng
dc.subject.otherpostoperative infectioneng
dc.subject.otherpractice guidelineeng
dc.subject.otherretrospective studyeng
dc.subject.otherrisk factoreng
dc.subject.otherseptic shockeng
dc.subject.othersurgical infectioneng
dc.subject.othersurgical mortalityeng
dc.subject.othersystemic therapyeng
dc.subject.othertreatment contraindicationeng
dc.subject.othertumor ablationeng
dc.subject.othertumor invasioneng
dc.titleLiver resection for hepatocellular carcinoma beyond the BCLC: are multinodular disease, portal hypertension, and portal system invasion real contraindications?eng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.citation.scopus3
hcfmusp.contributor.author-fmusphcANDREA ZAIDAN DE ALMEIDA BARROS
hcfmusp.contributor.author-fmusphcGILTON MARQUES FONSECA
hcfmusp.contributor.author-fmusphcJAIME ARTHUR PIROLA KRUGER
hcfmusp.contributor.author-fmusphcFABRICIO FERREIRA COELHO
hcfmusp.contributor.author-fmusphcPAULO HERMAN
hcfmusp.description.beginpage3123
hcfmusp.description.endpage3134
hcfmusp.description.issue6
hcfmusp.description.volume13
hcfmusp.origemSCOPUS
hcfmusp.origem.dimensionspub.1153880769
hcfmusp.origem.scopus2-s2.0-85145328794
hcfmusp.origem.wosWOS:001181814500019
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