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Long-Term Results of Liver Resection in the Treatment of Patients with Hepatocellular Carcinoma

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Grąt M., Hołówko W., Grzegorczyk K., Skalski M., Krawczyk M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 6
319-324
EN
The aim of the study was the analysis of the results of liver resection in the treatment of patients with hepatocellular carcinoma, taking into consideration the selected factors based on the department's material.Material and methods. Data of 122 patients subject to liver resection due to hepatocellular carcinoma at the Department of General, Transplantation and Liver Surgery, Medical University of Warsaw, were subject to retrospective analysis.The influence of selected factors on the long-term treatment results was determined, and the patient survival depending on the tumor stage as per the TNM scale was compared. The statistical significance threshold was set at p = 0.05.Results. 1- and 3-year overall survival and recurrence-free survival in the whole patient group was 82.1% and 56.3%, and 57.7% and 20.1%, respectively. The perioperative mortality rate was 1.6%. The neoplasm advancement exceeding the first stage on the TNM scale was associated with lower values of overall survival (p = 0.001, HR = 3.7) and recurrence-free survival (p = 0.00008, HR = 3.8). Elevation of AFP was the only independent prognostic factor for overall survival (p = 0.04, HR = 1.04 at alpha-fetoprotein levels > 1000 ng/ml), while the presence of neoplastic emboli in small blood vessels was an independent risk factor for HCC recurrence (p = 0.02, HR = 2.24).Conclusions. The alpha-fetoprotein levels and presence in the histopathological examination of neoplastic emboli in small blood vessels are independent prognostic factors for outcome of patients operated for hepatocellular carcinoma. The diagnosis of neoplasm at stage 1 as per TNM significantly improves long-term results of resective treatment.
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Early results of liver resection using laparoscopic technique

80%
Stranek M., Pędziwiatr M., Radkowiak D., Zychowicz A., Budzyński P., Major P., Budzyński A.
Polish Journal of Surgery
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2016
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vol. 88(1)
20-25
EN
The aim of the study was to present early outcomes of liver resection using laparoscopic technique. Material and methods. Retrospective analysis of patients who underwent liver resection using laparoscopic method was conducted. The analyzed group included 23 patients (11 women and 12 men). An average patient age was 61.3 years (37 – 83 years). Metastases of the colorectal cancer to the liver were the cause for qualification to the procedure of 15 patients, metastasis of breast cancer in 1 patient and primary liver malignancy in 5 patients. The other 2 patients were qualified to the liver resection to widen the surgical margins due to gall-bladder cancer diagnosed in the pathological assessment of the specimen resected during laparoscopic cholecystectomy, initially performed for other than oncology indications. Results. Hemihepatectomy was performed in 11 patients (9 right and 2 left), while the other 12 patients underwent minor resection procedures (5 metastasectomies, 4 nonanatomical liver resections, 1 bisegmentectomy, 2 resections of the gall-bladder fossa). An average duration of the surgical procedure was 275 minutes 65 – 600). An average size of the resected tumors was 28 mm (7 – 55 mm). In three cases conversion to laparotomy occurred, caused by excessive bleeding from the liver parenchyma. Postoperative complications were found in 4 patients (17.4%). Median hospitalization duration was 6 days (2 – 130 days). One patient (4.3%) was rehospitalized due to subhepatic abscess and required reoperation. Histopathology assessment confirmed radical resection (R0) in all patients in our group. Conclusion. Laparoscopic liver resections seem to be an interesting alternative in the treatment of focal lesions in the liver.
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Bile Duct Cysts

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Krawczyk M., Arkuszewski P., Zieniewicz K., Grąt M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 10
564-572
EN
Aim of the study was analysis of methods of surgical treatment of patients with bile duct cysts.Material and methods. Retrospective analysis of data from 30 patients who underwent surgical treatment for bile duct cysts in Clinic of General, Transplantation and Liver Surgery, Warsaw Medical University, between 1 October 2001 and 31 December 2009.Results. Bile duct cysts are more common in females; female to male ration is 4:1. Most of the treated patients had bile duct cysts belonging to type I according to Todani classification - 13 patients (43.3%). Six patients (20%) had type IV cysts, 8 patients (26.7%) had type V cysts according to Todani classification. Three patients (10%) with isolated intrahepatic bile duct cysts were not classified to any group according to Todani classification. The most common type of surgical treatment was complete resection of intrahepatic bile duct with choledocho-intestinal Roux-en-Y anastomosis that was performed in 17 patients (56.7%). The other patients generally underwent various types of resections of the liver and bile ducts or only of the liver. Five patients (16.7%) required liver transplantation. Nine patients (30%) developed complications. One patient (3.3%) who underwent liver transplantation and retransplantation, died from progressive multiorgan failure and renal failure.Conclusions. First line treatment of patients with bile duct cysts involves their resection, sometimes with requirement of resection of liver parenchyma. Most of these patients underwent reconstruction of bile duct through choledocho-intestinal Roux-en-Y anastomosis. Some patients undergo liver transplantation. Surgical treatment of patients with bile duct cysts is demanding from the technical point of view and should be undertaken in centers that specialize in hepatobiliary surgery.
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Comparison of Total Tumor Volume, Size and Number of Colorectal Liver Metastases in Prediction of Survival in Patients after Liver Resection

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Hołówko W., Grąt M., Wronka K. M., Stypułkowski J., Roszkowski R., Studnicki P., Krawczyk M.
Polish Journal of Surgery
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2015
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vol. 87
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issue 2
53-58
EN
Liver is the most common location of the colorectal cancer metastases occurrence. Liver resection is the only curative method of treatment. Unfortunately it is feasible only in 25% of patients with colorectal liver metastases, often because of the extensiveness of the disease. The aim of the study was to evaluate the predictive value of total tumor volume, size and number of colorectal liver metastases in patients treated with right hemihepatectomy. Material and methods. A retrospective analysis was performed in a group of 135 patients with colorectal liver metastases, who were treated with right hemihepatectomy. Total tumor volume was estimated based on the formula (4/3)πr3. Moreover, the study included an analysis of data on the number and size of tumors, radicality of the resection, time between primary tumor resection and liver resection, pre-operative blood serum concentration of carcinoembryonal antigen (CEA) and carcinoma antigen Ca19-9. The predictive value of the factors was evaluated by applying a Cox proportional hazards model and the area under the ROC curve. Results. The univariate analysis has shown the predictive value of size of the largest tumor (p=0.033; HR=1.065 per each cm) on the overall survival, however no predictive value of number of tumors (p=0.997; HR=1.000) and total tumor volume (p=0.212; HR=1.002) was observed. The multivariate analysis did not confirm the predictive value of the size of the largest tumor (p=0.141; HR=1.056). In the analysis of ROC curves, AUROC for the total tumor volume, the size of the largest tumor and the number of tumors were 0.629, 0.608, 0.520, respectively. Conclusions. Total tumor volume, size and number of liver metastases are not independent risk factors for the worse overall survival of patients with colorectal liver metastases treated with liver resection, therefore increased values of these factors should not be a contraindication for surgical treatment
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Evaluation of Outcomes and Treatment Safety of Patients with Metastatic Colorectal Cancer to the Liver with Estimation of Prognostic Factors

80%
Zeman M., Maciejewski A., Półtorak S., Kryj M.
Polish Journal of Surgery
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2013
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vol. 85
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issue 6
333-339
EN
Liver resection is essential part of colorectal cancer liver metastases (CLM) treatment. Mean 5-year overall survival after resection achieves 30-45%. There are many factors influencing long-term outcomes, and among them the inflammatory response to tumor plays an important role. The aim of the study was evaluation of outcomes and treatment safety of patients with metastatic colorectal cancer to the liver with estimation of prognostic factors. Material and methods. 130 consecutive patients (70 men and 60 women) operated in MSC Institute and Cancer Center in Gliwice from 2001 to 2009 due to colorectal liver metastases were analysed. Age of the patients ranged from 33 to 82 years (median 60 years). 96 (74%) patients underwent potentially radical resection, and in remaining 34 (26%) was performed radiofrequency ablation (RFA) alone or combined with the resection. In the resection group 37 right hepatectomies, 11 left hepatectomies, 28 segmentectomies and 20 metastasectomies were performed. Disease-free survival (DFS) and overall survival (OS) were statistically analysed using the Kaplan-Meier method. Factors determining DFS and OS were analysed using Cox regression model. Results. In the resection group the 3- and 5-years OS was 64,5% and 46,6% respectively, and the 3- and 5-years DFS was 32% and 30,5% respectively. In the RFA group the 3- and 5-years OS was 33% and 9,5%. Statistically significant prognostic factors in the resection group in uni- and multivariate analysis were: grade and nodal involvement of the primary tumor, diameter of metastatic focus, positive and narrow (<1 mm) resection margins, preoperative fibrinogen level, preoperative neutrophil to lymphocyte ratio and leukocyte amount of the peripheral blood. The perioperative mortality rate was 3%. Conclusions. Liver resection due to colorectal liver metastases is a safe and effective method resulting in high survival rates. We confirmed some generally accepted prognostic factors influencing longterm outcomes and shown the impact of inflammatory response. We also confirmed the hypothesis that preoperative plasma fibrinogen level influences outcomes after liver resection due to CLM.
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