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
ARTICLE HIGHLIGHTS
Research background

Reduction hepatectomy combined with multidisciplinary postoperative treatment should be considered as a treatment option for unresectable advanced hepatocellular carcinoma (HCC) that is not indicated for curative hepatectomy. A well designed and/or larger cohort study is required to further evaluate this treatment strategy.

Research motivation

Reduction hepatectomy combined with multidisciplinary postoperative treatment for unresectable advanced HCC that was not indicated for curative hepatectomy was effective when postoperative complete remission (POCR) was achieved through multidisciplinary postoperative therapy. To achieve POCR, reduction hepatectomy should aim to ensure that ≤ 3 tumors remain in the remnant liver. In cases in which POCR is not achieved, tyrosine kinase inhibitors (TKIs). can improve survival outcomes when administered as part of postoperative multidisciplinary therapy after reduction hepatectomy.

Research objectives

The 5-year overall survival rate and mean survival time (MST) for all cases after reduction hepatectomy were 15.7% and 28.40 mo, respectively. POCR, tumor size, major vascular invasion, and the number of tumors in the remnant liver after the reduction hepatectomy were found to be related to survival outcomes. In the POCR (+) and POCR (-) groups, the MST was 56.55 mo and 14.84 mo, respectively (P = 0.0041). 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).

Research methods

Thirty cases of advanced HCC, in which reduction hepatectomy was performed between 2000 and 2018 at the Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, were retrospectively investigated. These 30 cases were divided into two groups, the POCR (+) and POCR (-) groups, according to whether postoperative complete remission (POCR) of the evaluable lesions was achieved through postoperative treatment. Further analyses were performed after dividing the POCR (-) cases into two groups, the POCR (-) TKI (+) and POCR (-) TKI (-) groups, depending on whether TKIs were administered postoperatively.

Research results

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

Research conclusions

To date, few studies have evaluated combination treatment with reduction hepatectomy and multidisciplinary postoperative treatment for advanced HCC that is not indicated for curative hepatectomy.

Research perspectives

The prognosis of advanced HCC that is not indicated for curative hepatectomy remains poor, despite advances in the treatment of HCC including the development of tyrosine kinase inhibitors.