General surgery

Compared to surgery, percutaneous liver ablation interventions (IRs) in patients with hepatocellular carcinoma (HCC) are associated with lower inhospital mortality, length of hospital stay (LOS), and hospitalization costs, according to a study to be presented at the ARRS 2019 Annual Meeting, set for May 5-10 in Honolulu, HI.

Locoregional liver interventions

The study is conduct to compare use rates and outcomes of locoregional liver interventions IRs for HCC with surgical procedures. A total of 557,071 hospitalizations in patients with HCC from 2002 to 2015 are extract from the National Inpatient Sample database, with an estimate 13,618 IRs and 44,629 surgical procedures performed.

Hospitalizations with coexisting diagnoses of secondary hepatic and primary biliary malignancies, neuroendocrine tumors and benign hepatobiliary neoplasms, and traumatic liver injuries are exclude from the study. Over the 14-year period, unadjusted inhospital mortality rate, LOS, and hospitalization costs are higher for surgical procedures, and after adjusting for comorbidity score, year, and patient- and hospital-specific factors, results showed IR was associated with 78% lower inhospital mortality, 37% higher routine discharge to home, 67% lower LOS, and 71% lower cost.

Traumatic liver injuries

The optimal surgical strategy for hepatocellular carcinoma (HCC) is an ongoing debate. When considering liver resection for HCC; the extent of radical resection required to resolve the tumor burden; as well as the functional reserve of the diseased liver; and the volume of the future liver remnant must be take into account.

In addition, liver transplantation (LT); which can potentially cure both the diseased liver and HCC, is now an established surgical treatment for patients with HCC. Numerous methods for estimating the liver functional reserve and algorithms for surgical strategy in the treatment of HCC are available.

This review discusses the current opinions regarding resection and LT for HCC. Because The required remnant liver volume depends on the liver function in those with chronic liver dysfunction; as proposed by Torzilli et al; the worse liver function is, the smaller the liver volume that can be resected safely.

Baseline liver function

For example, 30% liver remnant may be sufficient in patients with normal liver function; but a higher percentage of liver remnant is recommend when baseline liver function is abnormal. The most reliable method for estimating the liver functional reserve has not yet been clarified.
This uncertainty is in respect of more HCC sufferers who are mostly cirrhotic; because operative mortality is still significant in some series. There are several methods for estimating the liver functional reserve which include the indocyanine-green retention rate at 15 minutes, 99mTc-galactosyl human serum albumin scintigraphy; and 13C-Methacetin Breath Test (LiMAx.