Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2021; 13(10): 1245-1257
Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1245
Outcomes of reduction hepatectomy combined with postoperative multidisciplinary therapy for advanced hepatocellular carcinoma
Yoh Asahi, Toshiya Kamiyama, Tatsuhiko Kakisaka, Tatsuya Orimo, Shingo Shimada, Akihisa Nagatsu, Takeshi Aiyama, Yuzuru Sakamoto, Hirofumi Kamachi, Akinobu Taketomi
Yoh Asahi, Toshiya Kamiyama, Tatsuhiko Kakisaka, Tatsuya Orimo, Shingo Shimada, Akihisa Nagatsu, Takeshi Aiyama, Yuzuru Sakamoto, Hirofumi Kamachi, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan
Author contributions: Asahi Y analyzed and interpreted the patient data, was involved in the data acquisition, made substantial contributions to the study conception and design, and was a major contributor during the writing of the manuscript; Kamiyama T participated in drafting and critically revising the article; Kakisaka T, Orimo T, Shimada S, Nagatsu A, Aiyama T, Sakamoto Y and Kamachi H revised the draft manuscript by adding intellectual insights and providing critical advice; Taketomi A provided critical comments to improve the manuscript and gave final approval for its submission; all of the authors have read and approved the final manuscript.
Institutional review board statement: This research was approved by the institutional review board of Hokkaido University Hospital.
Informed consent statement: Informed consent of patients was obtained in the form of opt-out on the web site of Hokkaido University Hospital.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yoh Asahi, MD, PhD, Surgeon, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo 060-8638, Hokkaido, Japan. yoh-hibana@yk2.so-net.ne.jp
Received: April 19, 2021
Peer-review started: April 19, 2021
First decision: August 9, 2021
Revised: August 21, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: October 27, 2021
Processing time: 189 Days and 16.7 Hours
Abstract
BACKGROUND

The prognosis of advanced hepatocellular carcinoma (HCC) that is not indicated for curative hepatectomy remains poor, despite advances in the treatment of HCC, including the development of tyrosine kinase inhibitors (TKIs). The outcomes of reduction hepatectomy and multidisciplinary postoperative treatment for advanced HCC that is not indicated for curative hepatectomy, including those of recently treated cases, should be investigated.

AIM

To examine the outcomes of combination treatment with reduction hepatectomy and multidisciplinary postoperative treatment for advanced HCC that is not indicated for curative hepatectomy.

METHODS

Thirty cases of advanced HCC that were not indicated for curative hepatectomy, in which reduction hepatectomy was performed between 2000 and 2018 at the Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, were divided into postoperative complete remission (POCR) (+) and POCR (-) groups, depending on whether POCR of all evaluable lesions was achieved through postoperative treatment. The cases in the POCR (-) group were subdivided into POCR (-) TKI (+) and POCR (-) TKI (-) groups, depending on whether TKIs were administered postoperatively.

RESULTS

The 5-year overall survival rate and mean survival time (MST) after reduction hepatectomy were 15.7% and 28.40 mo, respectively, for all cases; 37.5% and 56.55 mo, respectively, in the POCR (+) group; and 6.3% and 14.84 mo, respectively, in the POCR (-) group (P = 0.0041). Tumor size, major vascular invasion, and the number of tumors in the remnant liver after the reduction hepatectomy were also found to be related to survival outcomes. The number of tumors in the remnant liver was the only factor that differed significantly between the POCR (+) and POCR (-) groups, and POCR was achieved significantly more frequently when ≤ 3 tumors remained in the remnant liver (P = 0.0025). The MST was 33.52 mo in the POCR (-) TKI (+) group, which was superior to the MST of 10.74 mo seen in the POCR (-) TKI (-) group (P = 0.0473).

CONCLUSION

Reduction hepatectomy combined with multidisciplinary postoperative treatment for unresectable advanced HCC that was not indicated for curative hepatectomy was effective when POCR was achieved via multidisciplinary postoperative therapy. To achieve POCR, reduction hepatectomy should aim to ensure that ≤ 3 tumors remain in the remnant liver. Even in cases in which POCR is not achieved, combined treatment with reduction hepatectomy and multidisciplinary therapy can improve survival outcomes when TKIs are administered.

Keywords: Hepatocellular carcinoma, Reduction hepatectomy, Multidisciplinary therapy, Tyrosine kinase inhibitors, Postoperative complete remission

Core Tip: This was a retrospective study examining the outcomes of combination treatment with reduction hepatectomy and multidisciplinary postoperative treatment for advanced hepatocellular carcinoma (HCC). When reduction hepatectomy is performed for unresectable advanced HCC that is not indicated for curative hepatectomy, achieving postoperative complete remission (POCR) via postoperative multidisciplinary therapy is the key to success, with the 5-year overall survival rate and mean survival time for the POCR (+) group being 37.5% and 56.55 mo, respectively. To achieve POCR, reduction hepatectomy should be performed with the aim of reducing the number of tumors in the remnant liver to ≤ 3. Even in cases in which POCR is not achieved, tyrosine kinase inhibitor treatment might improve the prognosis of advanced HCC after reduction hepatectomy.