Patient Selection for Surgical Management of Primary and Metastatic Liver Cancers: Current Perspectives

 

 Buy Article Permissions and Reprints

ABSTRACT

The surgical management of liver malignancies remains a mainstay in the treatment of such patients, and has benefited from dramatic advancements over the last two decades. Improvements in surgical technique, better understanding of hepatic anatomy, and improvement in anesthesiological supportive care has resulted in a decline in perioperative morbidity and operative mortality. Proper patient selection for surgical and nonsurgical treatment currently employs a multidisciplinary approach in our institution. This review will focus on the surgical treatment options for both primary and secondary liver cancers.

REFERENCES

• 1 Poon R T, Fan S T, Lo C M et al.. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years.  Ann Surg. 2001;  234 63-70
  CrossrefPubMedGoogle Scholar
• 2 Gibbs J F, Litwin A, Kahlenberg M S. Contemporary management of benign liver tumors.  Surg Clin North Am. 2004;  84 463-480
  CrossrefPubMedGoogle Scholar
• 3 Shoup M, Gonen M, D'Angelica M et al.. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection.  J Gastrointest Surg. 2003;  7 325-330
  CrossrefPubMedGoogle Scholar
• 4 Blumgart L H, Leach K G, Karran S J. Observations on liver regeneration after right hepatic lobectomy.  Gut. 1971;  12 922-928
  PubMedGoogle Scholar
• 5 Lee K C, Kinoshita H, Hirohashi K, Kubo S, Iwasa R. Extension of surgical indications for hepatocellular carcinoma by portal vein embolization.  World J Surg. 1993;  17 109-115
  Google Scholar
• 6 Kinoshita H, Sakai K, Hirohashi K, Igawa S, Yamasaki O, Kubo S. Preoperative portal vein embolization for hepatocellular carcinoma.  World J Surg. 1986;  10 803-808
  Google Scholar
• 7 Wakabayashi H, Ishimura K, Okano K et al.. Application of preoperative portal vein embolization before major hepatic resection in patients with normal or abnormal liver parenchyma.  Surgery. 2002;  131 26-33
  Google Scholar
• 8 Farges O, Belghiti J, Kianmanesh R et al.. Portal vein embolization before right hepatectomy: prospective clinical trial.  Ann Surg. 2003;  237 208-217
  Google Scholar
• 9 Azoulay D, Castaing D, Krissat J et al.. Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver.  Ann Surg. 2000;  232 665-672
  CrossrefPubMedGoogle Scholar
• 10 Elias D, De Baere T, Roche A, Ducreux M, Leclere J, Lasser P. During liver regeneration following right portal embolization the growth rate of liver metastases is more rapid than that of the liver parenchyma.  Br J Surg. 1999;  86 784-788
  Google Scholar
• 11 Wakabayashi H, Ishimura K, Okano K et al.. Is preoperative portal vein embolization effective in improving prognosis after major hepatic resection in patients with advanced-stage hepatocellular carcinoma?.  Cancer. 2001;  92 2384-2390
  CrossrefPubMedGoogle Scholar
• 12 Gibbs J F, Weber T K, Rodriguez-Bigas M A, Driscoll D L, Petrelli N J. Intraoperative determinants of unresectability for patients with colorectal hepatic metastases.  Cancer. 1998;  82 1244-1249
  PubMedGoogle Scholar
• 13 Kane J M, Kahlenberg M S, Kanter P M et al.. Intraoperative hepatic lymphatic mapping in patients with colorectal liver metastases.  Am Surg. 2002;  68 745-750
  PubMedGoogle Scholar
• 14 Staren E D, Gambla M, Deziel D J et al.. Intraoperative ultrasound in the management of liver neoplasms.  Am Surg. 1997;  63 591-596 , discussion 596-597
  PubMedGoogle Scholar
• 15 Jarnagin W R, Bach A M, Winston C B et al.. What is the yield of intraoperative ultrasonography during partial hepatectomy for malignant disease?.  J Am Coll Surg. 2001;  192 577-583
  CrossrefPubMedGoogle Scholar
• 16 Antonetti M C, Killelea B, Orlando III R. Hand-assisted laparoscopic liver surgery.  Arch Surg. 2002;  137 407-411 , discussion 412
  PubMedGoogle Scholar
• 17 Dulucq J L, Wintringer P, Stabilini C, Berticelli J, Mahajna A. Laparoscopic liver resections: a single center experience.  Surg Endosc. 2005;  19 886-891
  CrossrefPubMedGoogle Scholar
• 18 Gigot J F, Glineur D, Santiago Azagra J et al.. Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study.  Ann Surg. 2002;  236 90-97
  CrossrefPubMedGoogle Scholar
• 19 Fong Y, Jarnagin W, Conlon K C, DeMatteo R, Dougherty E, Blumgart L H. Hand-assisted laparoscopic liver resection: lessons from an initial experience.  Arch Surg. 2000;  135 854-859
  CrossrefPubMedGoogle Scholar
• 20 Marks J, Mouiel J, Katkhouda N, Gugenheim J, Fabiani P. Laparoscopic liver surgery: a report on 28 patients.  Surg Endosc. 1998;  12 331-334
  CrossrefPubMedGoogle Scholar
• 21 Parkin D M, Pisani P, Ferlay J. Global cancer statistics.  CA Cancer J Clin. 1999;  49 33-64
  CrossrefPubMedGoogle Scholar
• 22 Ebara M, Hatano R, Fukuda H, Yoshikawa M, Sugiura N, Saisho H. Natural course of small hepatocellular carcinoma with underlying cirrhosis: a study of 30 patients.  Hepatogastroenterology. 1998;  45(suppl 3) 1214-1220
  PubMedGoogle Scholar
• 23 Fong Y, Sun R L, Jarnagin W, Blumgart L H. An analysis of 412 cases of hepatocellular carcinoma at a Western center.  Ann Surg. 1999;  229 790-799 , discussion 799-800
  CrossrefPubMedGoogle Scholar
• 24 Llovet J M, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation.  Hepatology. 1999;  30 1434-1440
  CrossrefPubMedGoogle Scholar
• 25 Margarit C, Hidalgo E, Charco R et al.. [Improvement in the results of surgical resection of hepatocellular carcinoma].  Gastroenterol Hepatol. 2001;  24 465-472
  PubMedGoogle Scholar
• 26 Kanematsu T, Furui J, Yanaga K, Okudaira S, Shimada M, Shirabe K. A 16-year experience in performing hepatic resection in 303 patients with hepatocellular carcinoma: 1985-2000.  Surgery. 2002;  131(suppl) S153-S158
  CrossrefPubMedGoogle Scholar
• 27 Grazi G L, Cescon M, Ravaioli M et al.. Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics: evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre.  Aliment Pharmacol Ther. 2003;  17(suppl 2) 119-129
  PubMedGoogle Scholar
• 28 Ercolani G, Grazi G L, Ravaioli M et al.. Liver resection for hepatocellular carcinoma on cirrhosis: univariate and multivariate analysis of risk factors for intrahepatic recurrence.  Ann Surg. 2003;  237 536-543
  CrossrefPubMedGoogle Scholar
• 29 Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma.  Ann Surg. 2003;  238 703-710
  CrossrefPubMedGoogle Scholar
• 30 Bismuth H. Hepatocellular carcinoma in the elderly: results of surgical and nonsurgical management.  Am J Gastroenterol. 1999;  94 2336-2337
  CrossrefPubMedGoogle Scholar
• 31 Lui W Y, Chau G Y, Wu C W, King K L. Surgical resection of hepatocellular carcinoma in elderly cirrhotic patients.  Hepatogastroenterology. 1999;  46 640-645
  PubMedGoogle Scholar
• 32 Makino Y, Yamanoi A, Kimoto T, El-Assal O N, Kohno H, Nagasue N. The influence of perioperative blood transfusion on intrahepatic recurrence after curative resection of hepatocellular carcinoma.  Am J Gastroenterol. 2000;  95 1294-1300
  CrossrefPubMedGoogle Scholar
• 33 Haug C E, Jenkins R L, Rohrer R J et al.. Liver transplantation for primary hepatic cancer.  Transplantation. 1992;  53 376-382
  PubMedGoogle Scholar
• 34 McCormack L, Petrowsky H, Clavien P A. Surgical therapy of hepatocellular carcinoma.  Eur J Gastroenterol Hepatol. 2005;  17 497-503
  CrossrefPubMedGoogle Scholar
• 35 Lau W Y, Leung T W, Ho S K et al.. Adjuvant intra-arterial iodine-131-labelled lipiodol for resectable hepatocellular carcinoma: a prospective randomised trial.  Lancet. 1999;  353 797-801
  CrossrefPubMedGoogle Scholar
• 36 Li J Q, Zhang Y Q, Zhang W Z, Yuan Y F, Li G H. Randomized study of chemoembolization as an adjuvant therapy for primary liver carcinoma after hepatectomy.  J Cancer Res Clin Oncol. 1995;  121 364-366
  CrossrefPubMedGoogle Scholar
• 37 Majno P E, Adam R, Bismuth H et al.. Influence of preoperative transarterial lipiodol chemoembolization on resection and transplantation for hepatocellular carcinoma in patients with cirrhosis.  Ann Surg. 1997;  226 688-701 , discussion 701-703
  CrossrefPubMedGoogle Scholar
• 38 Llovet J M, Schwartz M, Mazzaferro V. Resection and liver transplantation for hepatocellular carcinoma.  Semin Liver Dis. 2005;  25 181-200
  Article in Thieme ConnectPubMedGoogle Scholar
• 39 Paye F, Jagot P, Vilgrain V, Farges O, Borie D, Belghiti J. Preoperative chemoembolization of hepatocellular carcinoma: a comparative study.  Arch Surg. 1998;  133 767-772
  PubMedGoogle Scholar
• 40 Wu C C, Ho Y Z, Ho W L, Wu T C, Liu T J, P'Eng F K. Preoperative transcatheter arterial chemoembolization for resectable large hepatocellular carcinoma: a reappraisal.  Br J Surg. 1995;  82 122-126
  CrossrefPubMedGoogle Scholar
• 41 Yamasaki S, Hasegawa H, Kinoshita H et al.. A prospective randomized trial of the preventive effect of pre-operative transcatheter arterial embolization against recurrence of hepatocellular carcinoma.  Jpn J Cancer Res. 1996;  87 206-211
  PubMedGoogle Scholar
• 42 Fong Y. Surgical therapy of hepatic colorectal metastasis.  CA Cancer J Clin. 1999;  49 231-255
  PubMedGoogle Scholar
• 43 Kooby D A, Jarnagin W R. Surgical management of hepatic malignancy.  Cancer Invest. 2004;  22 283-303
  CrossrefPubMedGoogle Scholar
• 44 Bengmark S, Hafstrom L. The natural history of primary and secondary malignant tumors of the liver. II: the prognosis for patients with hepatic metastases from gastric carcinoma verified by laparotomy and postmortem examination.  Digestion. 1969;  2 179-186
  PubMedGoogle Scholar
• 45 Wood C B, Gillis C R, Blumgart L H. A retrospective study of the natural history of patients with liver metastases from colorectal cancer.  Clin Oncol. 1976;  2 285-288
  PubMedGoogle Scholar
• 46 Willett C G, Tepper J E, Cohen A M, Orlow E, Welch C E. Failure patterns following curative resection of colonic carcinoma.  Ann Surg. 1984;  200 685-690
  PubMedGoogle Scholar
• 47 Saltz L B, Cox J V, Blanke C et al.. Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group.  N Engl J Med. 2000;  343 905-914
  CrossrefPubMedGoogle Scholar
• 48 Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases.  World J Surg. 1995;  19 59-71
  Google Scholar
• 49 Fong Y, Fortner J, Sun R L, Brennan M F, Blumgart L H. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.  Ann Surg. 1999;  230 309-318 , discussion 318-321
  CrossrefPubMedGoogle Scholar
• 50 Nordlinger B, Guiguet M, Vaillant J C et al.. Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie.  Cancer. 1996;  77 1254-1262
  CrossrefPubMedGoogle Scholar
• 51 Fong Y, Cohen A M, Fortner J G et al.. Liver resection for colorectal metastases.  J Clin Oncol. 1997;  15 938-946
  CrossrefPubMedGoogle Scholar
• 52 Jamison R L, Donohue J H, Nagorney D M, Rosen C B, Harmsen W S, Ilstrup D M. Hepatic resection for metastatic colorectal cancer results in cure for some patients.  Arch Surg. 1997;  132 505-510 , discussion 511
  PubMedGoogle Scholar
• 53 Choti M A, Sitzmann J V, Tiburi M F et al.. Trends in long-term survival following liver resection for hepatic colorectal metastases.  Ann Surg. 2002;  235 759-766
  CrossrefPubMedGoogle Scholar
• 54 Adson M A, van Heerden J A, Adson M H, Wagner J S, Ilstrup D M. Resection of hepatic metastases from colorectal cancer.  Arch Surg. 1984;  119 647-651
  PubMedGoogle Scholar
• 55 Khushalani N I, McKinley B P, Gibbs J F, Leichman C G, Petrelli N J. Regional chemotherapy is indicated after surgical resection of colorectal metastases to the liver: a debate.  J Surg Oncol. 2003;  82 65-72
  CrossrefPubMedGoogle Scholar
• 56 Kemeny N, Gonen M, Sullivan D et al.. Phase I study of hepatic arterial infusion of floxuridine and dexamethasone with systemic irinotecan for unresectable hepatic metastases from colorectal cancer.  J Clin Oncol. 2001;  19 2687-2695
  PubMedGoogle Scholar
• 57 Chamberlain R S, Canes D, Brown K T et al.. Hepatic neuroendocrine metastases: does intervention alter outcomes?.  J Am Coll Surg. 2000;  190 432-445
  CrossrefPubMedGoogle Scholar
• 58 Que F G, Nagorney D M, Batts K P, Linz L J, Kvols L K. Hepatic resection for metastatic neuroendocrine carcinomas.  Am J Surg. 1995;  169 36-42 , discussion 42-43
  CrossrefPubMedGoogle Scholar
• 59 Dousset B, Saint-Marc O, Pitre J, Soubrane O, Houssin D, Chapuis Y. Metastatic endocrine tumors: medical treatment, surgical resection, or liver transplantation.  World J Surg. 1996;  20 908-914
  CrossrefPubMedGoogle Scholar
• 60 Chen H, Hardacre J M, Uzar A, Cameron J L, Choti M A. Isolated liver metastases from neuroendocrine tumors: does resection prolong survival?.  J Am Coll Surg. 1998;  187 88-92
  CrossrefPubMedGoogle Scholar
• 61 Elias D, Cavalcanti de Albuquerque A, Eggenspieler P et al.. Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients.  J Am Coll Surg. 1998;  187 487-493
  CrossrefPubMedGoogle Scholar
• 62 DeMatteo R P, Shah A, Fong Y, Jarnagin W R, Blumgart L H, Brennan M F. Results of hepatic resection for sarcoma metastatic to liver.  Ann Surg. 2001;  234 540-547 , discussion 547-548
  CrossrefPubMedGoogle Scholar
• 63 Elias D, Lasser P H, Montrucolli D, Bonvallot S, Spielmann M. Hepatectomy for liver metastases from breast cancer.  Eur J Surg Oncol. 1995;  21 510-513
  CrossrefPubMedGoogle Scholar
• 64 Gournay J, Tchuenbou J, Richou C et al.. Percutaneous ethanol injection vs. resection in patients with small single hepatocellular carcinoma: a retrospective case-control study with cost analysis.  Aliment Pharmacol Ther. 2002;  16 1529-1538
  CrossrefPubMedGoogle Scholar
• 65 Choti M A. Surgical management of hepatocellular carcinoma: resection and ablation.  J Vasc Interv Radiol. 2002;  13 S197-S203
  PubMedGoogle Scholar
• 66 Adam R, Hagopian E J, Linhares M et al.. A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies.  Arch Surg. 2002;  137 1332-1339 , discussion 1340
  CrossrefPubMedGoogle Scholar
• 67 Lencioni R A, Allgaier H P, Cioni D et al.. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection.  Radiology. 2003;  228 235-240
  CrossrefPubMedGoogle Scholar

John F GibbsM.D. 

Chair, Department of Gastrointestinal Surgery and Endoscopy

Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263