Recipient hepatectomy technique may affect oncological outcomes of Liver Transplantation for hepatocellular carcinoma.
Journal
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
ISSN: 1527-6473
Titre abrégé: Liver Transpl
Pays: United States
ID NLM: 100909185
Informations de publication
Date de publication:
01 Apr 2024
01 Apr 2024
Historique:
received:
19
07
2023
accepted:
14
03
2024
medline:
29
3
2024
pubmed:
29
3
2024
entrez:
29
3
2024
Statut:
aheadofprint
Résumé
To date, caval sparing (CS) and total caval replacement (TCR) for recipient hepatectomy in liver transplantation (LT) have been compared only in terms of surgical morbidity. Nonetheless, CS technique is inherently associated with an increased manipulation of the native liver and later exclusion of the venous outflow, which may increase the risk of intraoperative shedding of tumor cells when LT is performed for hepatocellular carcinoma (HCC). A multicenter, retrospective study was performed to assess the impact of recipient hepatectomy (CS vs. TCR) on the risk of post-transplant HCC recurrence, among 16 European Transplant Centers that used either TCR or CS recipient hepatectomy, as elective protocol technique. Exclusion criteria comprised cases of non-Center-protocol recipient hepatectomy technique, living-donor LT, HCC diagnosis suspected on preoperative imaging but not confirmed at pathological examination of the explanted liver, HCC in close contact with the inferior vena cava and previous liver resection for HCC. In 2420 patients, CS and TCR approaches were used in 1452 (60%) and 968 (40%) cases, respectively. Group adjustment with inverse probability weighting was performed for high volume center, recipient age, alcohol abuse, viral hepatitis, Child-Pugh class C, MELD score, cold ischemia time, clinical HCC stage within Milan criteria, pre-LT downstaging/bridging therapies, pre-LT AFP serum levels, number and size of tumor nodules, microvascular invasion and complete necrosis of all tumor nodules (matched cohort, TCR, n=938; CS, n=935). In a multivariate cause-specific hazard model, CS was associated with a higher risk of HCC recurrence(HR 1.536, p=0.007). TCR recipient hepatectomy, compared to CS approach, may be associated with some protective effect against post-LT tumor recurrence.
Sections du résumé
BACKGROUND
BACKGROUND
To date, caval sparing (CS) and total caval replacement (TCR) for recipient hepatectomy in liver transplantation (LT) have been compared only in terms of surgical morbidity. Nonetheless, CS technique is inherently associated with an increased manipulation of the native liver and later exclusion of the venous outflow, which may increase the risk of intraoperative shedding of tumor cells when LT is performed for hepatocellular carcinoma (HCC).
METHODS
METHODS
A multicenter, retrospective study was performed to assess the impact of recipient hepatectomy (CS vs. TCR) on the risk of post-transplant HCC recurrence, among 16 European Transplant Centers that used either TCR or CS recipient hepatectomy, as elective protocol technique. Exclusion criteria comprised cases of non-Center-protocol recipient hepatectomy technique, living-donor LT, HCC diagnosis suspected on preoperative imaging but not confirmed at pathological examination of the explanted liver, HCC in close contact with the inferior vena cava and previous liver resection for HCC.
RESULTS
RESULTS
In 2420 patients, CS and TCR approaches were used in 1452 (60%) and 968 (40%) cases, respectively. Group adjustment with inverse probability weighting was performed for high volume center, recipient age, alcohol abuse, viral hepatitis, Child-Pugh class C, MELD score, cold ischemia time, clinical HCC stage within Milan criteria, pre-LT downstaging/bridging therapies, pre-LT AFP serum levels, number and size of tumor nodules, microvascular invasion and complete necrosis of all tumor nodules (matched cohort, TCR, n=938; CS, n=935). In a multivariate cause-specific hazard model, CS was associated with a higher risk of HCC recurrence(HR 1.536, p=0.007).
CONCLUSIONS
CONCLUSIONS
TCR recipient hepatectomy, compared to CS approach, may be associated with some protective effect against post-LT tumor recurrence.
Identifiants
pubmed: 38551397
doi: 10.1097/LVT.0000000000000373
pii: 01445473-990000000-00356
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 American Association for the Study of Liver Diseases.