TY - JOUR
T1 - The role of resection in hepatocellular carcinoma BCLC stage B
T2 - A multi-institutional patient-level meta-analysis and systematic review
AU - Lopez-Lopez, Victor
AU - Kalt, Fabian
AU - Zhong, Jian-Hong
AU - Guidetti, Cristiano
AU - Magistri, Paolo
AU - Di Benedetto, Fabrizio
AU - Weinmann, Arndt
AU - Mittler, Jens
AU - Lang, Hauke
AU - Sharma, Rohini
AU - K, Vithayathil Mathew
AU - Tariq, Samir
AU - Sánchez-Velázquez, Patricia
AU - Rompianesi, Gianluca
AU - Troisi, Roberto Ivan
AU - Gómez-Gavara, Concepción
AU - Dalmau, Mar
AU - Sanchez-Romero, Francisco Jose
AU - Llamoza, Camilo
AU - Tschuor, Christoph
AU - Deniz, Uluk
AU - Lurje, Georg
AU - Husen, Peri
AU - Hügli, Sandro
AU - Jonas, Jan Philipp
AU - Rössler, Fabian
AU - Kron, Philipp
AU - Ramser, Michaela
AU - Ramirez, Pablo
AU - Lehmann, Kuno
AU - Robles-Campos, Ricardo
AU - Eshmuminov, Dilmurodjon
N1 - © 2024. The Author(s).
PY - 2024/9/13
Y1 - 2024/9/13
N2 - PURPOSE: The Barcelona Clinic Liver Cancer (BCLC) staging schema is widely used for hepatocellular carcinoma (HCC) treatment. In the updated recommendations, HCC BCLC stage B can become candidates for transplantation. In contrast, hepatectomy is currently not recommended.METHODS: This systematic review includes a multi-institutional meta-analysis of patient-level data. Survival, postoperative mortality, morbidity and patient selection criteria for liver resection and transplantation in BCLC stage B are explored. All clinical studies reporting HCC patients with BCLC stage B undergoing liver resection or transplantation were included.RESULTS: A total of 31 studies with 3163 patients were included. Patient level data was available for 580 patients from 9 studies (423 after resection and 157 after transplantation). The overall survival following resection was 50 months and recurrence-free survival was 15 months. Overall survival after transplantation was not reached and recurrence-free survival was 45 months. The major complication rate after resection was 0.11 (95%-CI, 0.0-0.17) with the 90-day mortality rate of 0.03 (95%-CI, 0.03-0.08). Child-Pugh A (93%), minor resection (60%), alpha protein level less than 400 (64%) were common in resected patients. Resected patients were mostly outside the Milan criteria (99%) with mean tumour number of 2.9. Studies reporting liver transplantation in BCLC stage B were scarce.CONCLUSION: Liver resection can be performed safely in selected patients with HCC BCLC stage B, particularly if patients present with preserved liver function. No conclusion can done on liver transplantation due to scarcity of reported studies.
AB - PURPOSE: The Barcelona Clinic Liver Cancer (BCLC) staging schema is widely used for hepatocellular carcinoma (HCC) treatment. In the updated recommendations, HCC BCLC stage B can become candidates for transplantation. In contrast, hepatectomy is currently not recommended.METHODS: This systematic review includes a multi-institutional meta-analysis of patient-level data. Survival, postoperative mortality, morbidity and patient selection criteria for liver resection and transplantation in BCLC stage B are explored. All clinical studies reporting HCC patients with BCLC stage B undergoing liver resection or transplantation were included.RESULTS: A total of 31 studies with 3163 patients were included. Patient level data was available for 580 patients from 9 studies (423 after resection and 157 after transplantation). The overall survival following resection was 50 months and recurrence-free survival was 15 months. Overall survival after transplantation was not reached and recurrence-free survival was 45 months. The major complication rate after resection was 0.11 (95%-CI, 0.0-0.17) with the 90-day mortality rate of 0.03 (95%-CI, 0.03-0.08). Child-Pugh A (93%), minor resection (60%), alpha protein level less than 400 (64%) were common in resected patients. Resected patients were mostly outside the Milan criteria (99%) with mean tumour number of 2.9. Studies reporting liver transplantation in BCLC stage B were scarce.CONCLUSION: Liver resection can be performed safely in selected patients with HCC BCLC stage B, particularly if patients present with preserved liver function. No conclusion can done on liver transplantation due to scarcity of reported studies.
KW - Carcinoma, Hepatocellular/surgery
KW - Liver Neoplasms/surgery
KW - Humans
KW - Hepatectomy
KW - Neoplasm Staging
KW - Liver Transplantation
KW - Patient Selection
KW - Survival Rate
UR - https://www.scopus.com/pages/publications/85203844823
U2 - 10.1007/s00423-024-03466-x
DO - 10.1007/s00423-024-03466-x
M3 - Journal article
C2 - 39269544
SN - 1435-2443
VL - 409
JO - Langenbeck's Archives of Surgery
JF - Langenbeck's Archives of Surgery
IS - 1
M1 - 277
ER -