Aim:This study aimed to compare mini-invasive liver resection(MILR)(laparoscopic/robotic approach)and open liver resection(OLR)for hepatocellular carcinoma(HCC)in elderly patients with regard to clinical and oncologic...Aim:This study aimed to compare mini-invasive liver resection(MILR)(laparoscopic/robotic approach)and open liver resection(OLR)for hepatocellular carcinoma(HCC)in elderly patients with regard to clinical and oncological outcomes through a comprehensive systematic review.Methods:The MEDLINE and Cochrane Library electronic databases were systematically searched from 2009 to December 2019 to identify relevant English written studies comparing MILR and OLR.The main endpoints were Child-Pugh score,serum total bilirubin level,comorbidity,presence/absence of cirrhosis,minor/major resection,challenge segment approach,operative time,estimated intraoperative blood loss,liver failure rate,morbidity according to the Clavien-Dindo classification,length of hospital stay(LOS),postoperative mortality,number of lesions,tumor size,readmission rate,recurrence rate and survival at 1,3 and 5 years after operation.Meta-analyses provided pooled relative risks and mean differences for these outcomes.Cut-off for"elderly age"was set at 65 years old.Results:Eight studies that evaluated 3051 patients who underwent liver resection for HCC,with 950 undergoing MILR and 2101 OLR,were included after the screening process.Blood loss,morbidity,and LOS showed statistical significance in favor of MILR.In particular,with respect to OLR,MILR decreased on average blood loss by 161.43 mL(95%CI:250.24-72.61),risk of morbidity by 42%(P<0.01),LOS by 4 days(95%CI:7-2),postoperative mortality risk by 47%(although not significantly,P=0.06).Major resections were significantly more common in the OLR group(P<0.0001).Recurrence,although not significant(P=0.06),must also be emphasized.The two surgical approaches were comparable with regard to the other outcomes investigated.Conclusion:Meta-analyses confirmed the advantages of MILR in terms of short perioperative outcomes,where it may promote the extension of liver resection to HCC patients with borderline liver function.MILR may be considered an important treatment option with significant benefits in the elderly and fragile patients.However,large well-designed prospective comparative studies or randomized controlled trials would be necessary to further confirm our conclusions.展开更多
The role of transarterial chemoembolization(TACE)in hepatocellular carcinoma(HCC)management has changed over the last twenty years.There has been a trend towards an overall decline in TACE procedures,but with a more a...The role of transarterial chemoembolization(TACE)in hepatocellular carcinoma(HCC)management has changed over the last twenty years.There has been a trend towards an overall decline in TACE procedures,but with a more aggressive approach,repeating multiple TACE sessions in case of tumor response.The survival of treated patients was prolonged because of better patient selection and advancements in TACE techniques aimed at preserving liver function.At present,TACE is approved by the International Guidelines also outside of the BCLC intermediate stage after evaluation of a multidisciplinary tumor board(MDTB),permitting a customized treatment for every patient.An alternative therapeutic strategy is represented by hepatic chemoembolization with Degradable Starch Microspheres(DSM-TACE),which is based on the chemotherapeutic effect rather than on the ischemic damage to the liver tumor,requiring multiple cycles of treatment.The higher safety profile of DSM-TACE has broadened the indications to patients waiting for liver transplantation(with bridging or downstaging intention),at high risk of liver failure and ineligible for systemic therapies.This review summarises the scientific publications supporting the use of DSM-TACE and illustrates its indications depending on the disease stage from the Interventional Radiologist’s perspective.展开更多
文摘Aim:This study aimed to compare mini-invasive liver resection(MILR)(laparoscopic/robotic approach)and open liver resection(OLR)for hepatocellular carcinoma(HCC)in elderly patients with regard to clinical and oncological outcomes through a comprehensive systematic review.Methods:The MEDLINE and Cochrane Library electronic databases were systematically searched from 2009 to December 2019 to identify relevant English written studies comparing MILR and OLR.The main endpoints were Child-Pugh score,serum total bilirubin level,comorbidity,presence/absence of cirrhosis,minor/major resection,challenge segment approach,operative time,estimated intraoperative blood loss,liver failure rate,morbidity according to the Clavien-Dindo classification,length of hospital stay(LOS),postoperative mortality,number of lesions,tumor size,readmission rate,recurrence rate and survival at 1,3 and 5 years after operation.Meta-analyses provided pooled relative risks and mean differences for these outcomes.Cut-off for"elderly age"was set at 65 years old.Results:Eight studies that evaluated 3051 patients who underwent liver resection for HCC,with 950 undergoing MILR and 2101 OLR,were included after the screening process.Blood loss,morbidity,and LOS showed statistical significance in favor of MILR.In particular,with respect to OLR,MILR decreased on average blood loss by 161.43 mL(95%CI:250.24-72.61),risk of morbidity by 42%(P<0.01),LOS by 4 days(95%CI:7-2),postoperative mortality risk by 47%(although not significantly,P=0.06).Major resections were significantly more common in the OLR group(P<0.0001).Recurrence,although not significant(P=0.06),must also be emphasized.The two surgical approaches were comparable with regard to the other outcomes investigated.Conclusion:Meta-analyses confirmed the advantages of MILR in terms of short perioperative outcomes,where it may promote the extension of liver resection to HCC patients with borderline liver function.MILR may be considered an important treatment option with significant benefits in the elderly and fragile patients.However,large well-designed prospective comparative studies or randomized controlled trials would be necessary to further confirm our conclusions.
文摘The role of transarterial chemoembolization(TACE)in hepatocellular carcinoma(HCC)management has changed over the last twenty years.There has been a trend towards an overall decline in TACE procedures,but with a more aggressive approach,repeating multiple TACE sessions in case of tumor response.The survival of treated patients was prolonged because of better patient selection and advancements in TACE techniques aimed at preserving liver function.At present,TACE is approved by the International Guidelines also outside of the BCLC intermediate stage after evaluation of a multidisciplinary tumor board(MDTB),permitting a customized treatment for every patient.An alternative therapeutic strategy is represented by hepatic chemoembolization with Degradable Starch Microspheres(DSM-TACE),which is based on the chemotherapeutic effect rather than on the ischemic damage to the liver tumor,requiring multiple cycles of treatment.The higher safety profile of DSM-TACE has broadened the indications to patients waiting for liver transplantation(with bridging or downstaging intention),at high risk of liver failure and ineligible for systemic therapies.This review summarises the scientific publications supporting the use of DSM-TACE and illustrates its indications depending on the disease stage from the Interventional Radiologist’s perspective.
