Chetana Lim1, Chady Salloum2, Michael Osseis2, Eylon Lahat2, Concepción Gómez-Gavara2, Philippe Compagnon3, Alain Luciani4, Cyrille Feray5, Daniel Azoulay6. 1. AP-HP Henri Mondor Hospital, Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Créteil, France; University Paris 12, UPEC, Créteil, France. 2. AP-HP Henri Mondor Hospital, Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Créteil, France. 3. AP-HP Henri Mondor Hospital, Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Créteil, France; University Paris 12, UPEC, Créteil, France; INSERM 955, Créteil, France. 4. University Paris 12, UPEC, Créteil, France; INSERM 955, Créteil, France; AP-HP Henri Mondor Hospital, Department of Radiology, Créteil, France. 5. University Paris 12, UPEC, Créteil, France; INSERM 955, Créteil, France; AP-HP Henri Mondor Hospital, Department of Hepatology, Créteil, France. 6. AP-HP Henri Mondor Hospital, Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Créteil, France; University Paris 12, UPEC, Créteil, France; INSERM 955, Créteil, France. Electronic address: daniel.azoulay@hmn.aphp.fr.
Abstract
BACKGROUND: Western guidelines recommend resection for hepatocellular carcinoma (HCC) in so-called ideal cirrhotic patients with a Barcelona Clinic Liver Cancer (BCLC) stage 0-A tumour. This study compares short-term outcomes following resection between patients defined as ideal and nonideal according to the BCLC guidelines. METHODS: This prospective single-centre open study (ClinicalTrials.govNCT02145013) included all cirrhotic patients with HCC referred for resection from 2014 to 2016. Mortality, morbidity, unresolved liver decompensation, and readmission were measured. RESULTS: The study population included 65 consecutive patients: 32 (49%) ideal and 33 (51%) nonideal. Ideal and nonideal groups did not differ in mortality (3% vs. 6%; p = 0.57), morbidity (53% vs. 73%; p = 0.10), or unresolved liver decompensation (6% vs. 15%; p = 0.23) at 90 days. The readmission rate was higher in the nonideal (21%) than in the ideal group (3%; p = 0.02). CONCLUSION: Straying from the current guidelines for resection in a selected subset of nonideal patients doubled the number of resections performed for treating HCC, with satisfactory short-term outcomes. These results argue for the expansion of the acknowledged BCLC guidelines.
BACKGROUND: Western guidelines recommend resection for hepatocellular carcinoma (HCC) in so-called ideal cirrhotic patients with a Barcelona Clinic Liver Cancer (BCLC) stage 0-A tumour. This study compares short-term outcomes following resection between patients defined as ideal and nonideal according to the BCLC guidelines. METHODS: This prospective single-centre open study (ClinicalTrials.govNCT02145013) included all cirrhotic patients with HCC referred for resection from 2014 to 2016. Mortality, morbidity, unresolved liver decompensation, and readmission were measured. RESULTS: The study population included 65 consecutive patients: 32 (49%) ideal and 33 (51%) nonideal. Ideal and nonideal groups did not differ in mortality (3% vs. 6%; p = 0.57), morbidity (53% vs. 73%; p = 0.10), or unresolved liver decompensation (6% vs. 15%; p = 0.23) at 90 days. The readmission rate was higher in the nonideal (21%) than in the ideal group (3%; p = 0.02). CONCLUSION: Straying from the current guidelines for resection in a selected subset of nonideal patients doubled the number of resections performed for treating HCC, with satisfactory short-term outcomes. These results argue for the expansion of the acknowledged BCLC guidelines.
Authors: Daniel Azoulay; Emilio Ramos; Margarida Casellas-Robert; Chady Salloum; Laura Lladó; Roy Nadler; Juli Busquets; Celia Caula-Freixa; Kristel Mils; Santiago Lopez-Ben; Joan Figueras; Chetana Lim Journal: JHEP Rep Date: 2020-10-08