Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1245
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
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.
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.
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).
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.
To investigate the outcomes of combination treatment with reduction hepatectomy and multidisciplinary postoperative treatment for advanced HCC that is not indicated for curative hepatectomy.
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.
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.