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![British Journal of Surgery 1997, 84, 1255 - 1259
Survivors (n = 113) Non-survivors (n = 14) P *
All ICG retention at 15 min (%) 11 (3 - 50) 18 (4 - 29) 0.008
Aminopyrine breath test (%) 4-4 (1.3 - 9.6) 4.3 (2.8 – 8.3) 0.69
Amino acid clearance test (1 m-2 min-1) 0.21(1.7 to 4.3) 0.15 (-0.2 to 0.9) 0.35
Albumin (g l-1) 42 (31 - 53) 41 (29 - 46) 0.40
Total bilirubin (μmol l-1) 9 (3 - 70) 14 (7 - 32) 0.05
Aspartate aminotransferase (units l-1) 59 (17 - 365) 97 (39 - 340) 0.02
Alanine aminotransferase (units l-1) 53 (9 - 480) 53 (21 - 322) 0.90
0
15
35
[IGC] mg %
Survivors
Distribution of indocyanine green (ICG) retention at
? in for survivors and patients who died in hospital
Non-survivors
5
25
40
10
20
45
30
127 hepatectomies dont 91 Majeures
Child A (n=121) / Child B (n=6)
Mortalité Hospitalière : 14/127 (11%)
Valeur seuil d’ICG à 15 minutes
15% pour les Hep. Maj
23% pour les Hep. Min.](https://image.slidesharecdn.com/resectionearlyhcc-140918061252-phpapp02/85/Resection-early-hcc-18-320.jpg)
Uploaded byEric Vibert, MD, PhD
Resection early hcc
This document summarizes information from a presentation on surgery for early-stage hepatocellular carcinoma (HCC). It discusses outcomes of liver resection for HCC tumors under 2 cm, including a 98% rate of complete radiological necrosis. It also examines factors like tumor size and number, presence of satellite nodules or cirrhosis that affect risk of recurrence. Additionally, it evaluates tools like indocyanine green retention at 15 minutes to assess liver functional reserve and risk of post-operative liver failure. The conclusion is that liver resection can cure early HCC when the patient has sufficient liver function and the surgery contains an adequate safety margin.
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- 1. Surgeryfor earlyHCC EricVibert,MD, PhD Centre Hépato Biliaire, Hop. Paul Brousse (AP/HP) -Villejuif
- 2. 218 patients avecCHC < 2 cm Suivi médian : 31 mois 26% Nécrose radiologique complète : 98% 2008 20%
- 3. 22.4% Février 2011 4977 patients (1998 –2003) 50 % HVC 30% HVB 20% Other
- 5.
- 6. 2013 16 /132 pts (12%) Satellites Nod. 1990 –2009 : New York + Milan -NY : Child A / No Portal Hypertension -Milan : Child A : ICG < 20% 132 pts / Mortalité Pst op 0.7%
- 7. Marge : 1cm vs 2 cm Suivi moyen : Marge 1 cm (39±17 mois) ; Marge 2 cm (43±15) 2007
- 8. For RF needlethatdestroya sphereof 3 cm diameter Diamètretumoral Nb de «ponction» 1 cm 1 1,75cm 6 3 cm 14 2002
- 9. No exploration ofthe liversurface ICG camera IOUS
- 10. 2013 CHC <3 cm
- 11. 1200 à 1500Greffons / an en France….
- 12. Waiting list :3 months to 1 year Inscription Transplantation Palliative Drop-out = 12% No Drop-out
- 13.
- 15. MELD >11 Sensitivity= 82% Specificity = 89% 0 20 40 60 80 100 0 20 40 60 80 100 Sensitivity 100 –Specificity MELD >9 Sensitivity = 87% Specificity = 63% 0 20 40 60 80 100 0 20 40 60 80 100 Sensitivity 100 –Specificity Post operative liver failure 1997 -2004 : 157 cirrhotic liver resections Post operative complications 2006 Child A : 93% / Minor resection : 95% / Mortality 7%
- 16.
- 17. Variables MELD score<9 (n=74) MELD score between 9 and 10 (n=56) MELD score > 11 (n=24) Postoperative liver failure 0 (0%) 2 (3.6%) 9 (37.5%) Postoperative complications 6 (8.1%) 20 (35.7%) 20 (83.3%) Refractory ascites 5 (6.8%) 15 (26.8%) 20 (83.3%) Jaundice 2 (2.7%) 10 (17.9%) 19 (79.2%) Alteration of coagulation factors 3 (4.1%) 12 (21.4%) 19 (79.2%) Renal impairment 0 (0%) 4 (7.1%) 6 (25%) Hospital stay (days) 8 (5-38) 9 (6-33) 25 (6-166) 1-year survival 100% 94% 74% No liver resection in cirrhotic patientwith a MELD Score superior to 12 2006
- 18. British Journal ofSurgery 1997, 84, 1255 - 1259 Survivors (n = 113) Non-survivors (n = 14) P * All ICG retention at 15 min (%) 11 (3 - 50) 18 (4 - 29) 0.008 Aminopyrine breath test (%) 4-4 (1.3 - 9.6) 4.3 (2.8 – 8.3) 0.69 Amino acid clearance test (1 m-2 min-1) 0.21(1.7 to 4.3) 0.15 (-0.2 to 0.9) 0.35 Albumin (g l-1) 42 (31 - 53) 41 (29 - 46) 0.40 Total bilirubin (μmol l-1) 9 (3 - 70) 14 (7 - 32) 0.05 Aspartate aminotransferase (units l-1) 59 (17 - 365) 97 (39 - 340) 0.02 Alanine aminotransferase (units l-1) 53 (9 - 480) 53 (21 - 322) 0.90 0 15 35 [IGC] mg % Survivors Distribution of indocyanine green (ICG) retention at ? in for survivors and patients who died in hospital Non-survivors 5 25 40 10 20 45 30 127 hepatectomies dont 91 Majeures Child A (n=121) / Child B (n=6) Mortalité Hospitalière : 14/127 (11%) Valeur seuil d’ICG à 15 minutes 15% pour les Hep. Maj 23% pour les Hep. Min.
- 19. 2008 1994-2004 :455 pts opérés pour CHC / Suivi moy.: 46 mois 384 pts avec fibroscopie pré-opératoire Child A / Sans HTP 56% 71% Child A / Avec HTP Définition de l’HTP : VO et/ou plq < 100 000/ml + Splénomégalie
- 20. 2003 PVE isan«effort test» for the pathologicalliver…
- 21. The interest… Totreata problemand to plan the futur
- 22. Into the parenchyma Into the HCC If recurrence Salvage LT Preemptive LT Bridge LT Early Recurrence Late Recurrence CI à la TH ? Test of time… Scatton et al. Liver Transpl. Fuks et al. Hepatology Swiss Watch
- 23. Taux de transplantationsecondaire en cas de récidive : 28% 2011
- 24. 1 -Peu différencié 2 -Inv. Vasc. micro 3 -Nodules satellites 4-Cirrhose (F4) 5 -Diamètre > 3 cm Récidive dans Milan 65% de TH Salvage
- 25. Log rank p=0.038 100% 56% 78% 41% 100% 81% Living donor : 11 Cadaveric donor : 22 Salvage Transplantation for HCC on cirrhotic liver Overall Survival (Paul Brousse Experience)
- 26. MILAN IN (Specimen) MILAN Out (Specimen) Mai 2011
- 27. 5 Gènes :TAF9, RAMP3, HN1, KRT19, RAN
- 30.
- 32.
- 33. The location ofHCC… LiverSPby SIGHT
- 34. In conclusion… Itwaspossible to cure a patient withearlyHCCby liverresectionthatcontaina safetymarginif the patient hadenoughliverfonctionalreserveto support surgery… Wedidnot plan the futurof the patientSby destruction of the presentbut by itscarefulanalysis… Thanksfor yourattention eric.vibert.pbr@gmail. com This slides willbeon slides share