Background: Liver transplantation for hepatic tumours is known as a proven treatment opportunity. The outcome has improved over the past decades because of the appropriate recipient selection.
Materials and methods: In a single-institution study of 29 consecutive adult patients underwent orthotopic liver transplantation (OLT) between 1 January 2004 and 1 January 2011 in the Semmelweis University, Budapest with the indication of hepatocellular carcinoma (HCC).
Results: The 1-year survival was 85.7% and the 3-year survival was 71.7%.
Conclusions: Further investigations are needed on the field of histological and biological attributes of the hepatocellular carcinoma. Our aim is to find a better and individualized immunosuppressive protocol, which is also protective against malignant tumours.
Introduction: Hepatocellular carcinoma is the most frequent primary malignant tumor of the liver, being linked in 80% of cases with viral hepatitis ”B” or “C”. Treatment remains a challenge especially in cases with associated hepatic cirrhosis, where preoperative arterial chemoembolization followed by liver resection is recommended.
Case report: We discuss the case of a 64 years old cirrhotic patient, diagnosed by echography, computed tomography, magnetic resonance cholangiography with hepatocellular carcinoma (64x52x46 mm). Preoperative chemoembolization was performed with Lipiodol and 5-FU by supra-selective catheterization of left hepatic artery, followed by favorable radiologic response. Two weeks after embolization, the patient was admitted in Surgical Clinic No. 1 Targu Mures where an atypical resection of the left hepatic lobe (bisegmentectomy II-III) was performed with Harmonic Scalpel. Early and late postoperative evolution was favorable.
Discussions: The principle of arterial chemoembolization is based on the fact that vasculature of primary hepatic tumors is predominantly arterial. Arterial obstruction may lead to ischemic necrosis while tumor embolization combination with a chemotherapeutic agent significantly improves its local concentration. Decrease in tumor size and its vasculature allows for safe hepatic resection especially in the cirrhotic liver.
Conclusion: In case of tumoral cirrhotic liver preoperative chemoembolization decreases intra and postoperative bleeding risk, providing a safe and oncological resection.
In the past 30 years a major progress was recorded in the management of the liver diseases. At the beginning of the years 1990 we considered most of the liver cirrhosis as alcoholic, as the viral markers were not available. Later on, when the etiology of liver cirrhosis was better established, the reality showed that viral B and C cirrhosis was prevalent in our country.
After 1990 a rigorous screening was implemented for donated blood, which led to a dramatically decrease in the transmission of the B and C hepatic viruses. Another preventive measure introduced by the health societies was to increase the efforts to educate the general public about hepatitis C and B, so that the number of people infected by tattooing or razors has significantly decreased since a more coherent preventive policy was implemented in this respect. After 1990 the antiviral treatment (interferon and molecules) became available.
The paper “Predictors of hepatocellular carcinoma (HCC) in patients with liver cirrhosis” is addressing a very important topic, the etiology of liver carcinoma. This cancer is now the fifth most common type of cancer (in men) and the second leading cause of cancer-related death worldwide (1). [More]