Treatment of recurrent hepatocellular carcinoma after liver transplantation in patients with recurrent hepatocellular carcinoma after hepatectomy: a case report and literature review of --1

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Abstract: Objective To summarize the experience of treatment of recurrent hepatocellular carcinoma (HCC) after liver transplantation in pati

Content

Abstract: Objective To summarize the experience of treatment of recurrent hepatocellular carcinoma (HCC) after liver transplantation in patients with recurrent hepatocellular carcinoma after hepatectomy. Methods a total of 1 patients with recurrent hepatocellular carcinoma were treated with orthotopic liver transplantation in General Hospital of the Air Force PLA in November 14, 2003. After liver transplantation (hereinafter referred to as surgery) 3 months after returning to hospital chemotherapy. 19 months after operation of liver transplantation for the first time found that the recurrence of hepatocellular carcinoma, then underwent percutaneous radiofrequency ablation, hepatic arterial chemoembolization, radiofrequency ablation and intraoperative hepatic left medial lobe tumor resection sequential treatment. At the end of 31 months, the recurrence of liver cancer was found in the transplanted liver, and the patients were treated with transcatheter arterial chemoembolization (TACE), right anterior Ye Zhongliu radiofrequency ablation (RFA) and resection of the right posterior lobe of the liver. 5 years after surgery found that portal vein thrombosis, abnormal liver function, the liver function liver, anticoagulation, supplemental albumin recovered gradually after treatment. Routine and anti HBV therapy in patients undergoing liver transplantation. Postoperative routine anti rejection drugs. Results the operation and postoperative recovery of the patients were smooth. 2 patients with liver cancer recurrence after liver transplantation were successfully cured, and no recurrence was found after the second recurrence. Hepatitis B virus DNA was less than 103copies/ml, and the patients were still alive and healthy. Conclusion the recurrence of hepatocellular carcinoma after resection of primary liver cancer, as long as the recurrence of liver cancer in line with China's Hangzhou standard, should still be active liver transplantation. For patients with hepatocellular carcinoma after liver transplantation, aggressive sequential combination therapy and surgical resection may still be cured.

Key words: primary liver cancer; resection; recurrence; liver transplantation

Liver transplantation for recurrence of primary liver carcinoma after resection and therapy of recurrent hepatocellular carcinoma at the liver graft (a long-term surviving case report and related literature review).

Abstract: Objective Outline the experience of of liver transplantation for 1 case recurrence of primary liver carcinoma after resection and the therapeutic measures for recurrent primary liver carcinoma of the newly transplanted liver. MethodsOne patient underwent liver transplantation because of recurrence of liver carcinoma after resection in Air Force General Hospital of Chinese PLA on November 14 The patient accepted venous chemotherapy, 2003 3 months later. 19 months after liver transplantation, recurrent primary liver carcinoma was found in the transplanted liver, and then the sequential therapy of radiofrequency ablation, hepatic artery chemotherapy and embolization, introperative radiofrequency ablation and tumorectomy were perfor Med respectively. 31 months after liver transplantation, recurrent primary liver carcinoma was again found in the transplanted liver, and then the sequential therapy of hepatic artery chemotherapy and embolization, introperative radiofrequency ablation and tumorectomy were performed also respectively. 5 years later after liver transplantation, dysfunction of liver emerged due to portal vein thrombus, then the patient underwent hepatoprotection. Anticoagulation, supplement of albumin and other treatments, and gradually gained restoration of liver function. Anti-HBV therapy was given to the patient during perioperative and postoperative period. Anti-rejection therapy was also given after liver transplantation. ResultsLiver grafting and Posto Perative recovery was successful. Therapeutic effects for twice relapses of primary liver carcinoma in the transplanted liver were satisfactory, and from then on no liver cancer relapse has emerged. The serum HBV DNA level of the patient was always controlled lower than 103 copies/ml. Up to now, the patient is still alive and healthy and has normal liver function. ConclusionFor the patient with recurrence of primary liver carcinoma after resection, liver transplantation can be undertaken if Hangzhou criteria was met. If the liver graft recurrs hepatocellular carcinoma, active sequential therapy and tumorectomy may attain satisfactory results and prolong the patient s life span. "

Key words: liver carcinoma; Resection; Recurrence; Liver transplantation; Primary

The Department of hepatobiliary surgery of General Hospital of the Air Force PLA in November 14, 2003 1 cases of recurrence after resection of hepatocellular carcinoma underwent orthotopic liver transplantation for the treatment of the patients after liver transplantation, new recurrent hepatocellular carcinoma 2 times, the comprehensive treatment effect is good, the report is as follows.

1 clinical data

1.1 general data, male, age 50. 7 years after resection of liver cancer, liver lesions were found in the hospital for 3 days in October 28, 2003. In 1996, hepatic artery angiography was performed in our hospital, and the patients were diagnosed as primary liver cancer. Liver resection and chemotherapy pump implantation". Postoperative recovery was good. After the chemotherapy pump intermittent injection of interleukin-2, letinous edodes polysaccharide "on February. Then 3 menstrual chemotherapy pump injection of interleukin-2 therapy "in 1997 and 2001, course in January. In May 2001, the right lobe of the liver was found to be more prone to be occupied, and the interventional embolization was performed 2 times. In 2002, CT guided percutaneous transhepatic hepatic ethanol injection for 2 times, tumor necrosis. Patients with liver lesions in the left lobe of the liver were found in October 25, 2003, and the recurrence of liver cancer was considered. Half a month before admission from sleep, mild abdominal distension, normal urine, anorexia, weight was not significantly reduced. In 1981 suffering from hepatitis B, liver protection drug treatment service interruption. Duodenal ulcer occurred in 2001 after embolization (the endoscopic diagnosis), after treatment. Admitted to the hospital: emaciated. No yellow skin and sclera. The abdomen flat, no abdominal varices, visible right upper abdominal subcostal incision scar length of about 20cm, chemotherapy pump implantation process visible previous surgery incision for middle abdominal subcutaneous. The abdomen is soft, no tenderness and rebound tenderness, can touch the chemotherapy pump body, liver and spleen rib were not palpable, Murphy negative syndrome. Lung and liver dullness in the right fifth intercostal space, double and double kidney hypochondriac region area without percussion pain, shifting dullness. Normal bowel sounds. Abdominal B ultrasound showed: after partial resection of liver cancer, multiple solid lesions in the liver; after cholecystectomy, spleen, double kidney pattern was not abnormal; hepatic vein, portal vein, inferior vena cava blood flow was not abnormal. After admission, abdominal CT: after resection of liver cancer, liver diffuse multiple size of the occupying lesions, ranging from 1.0cm~6.5cm in diameter, the largest is located in the right lobe of the liver, considering the recurrence of liver cancer. Test blood type "A", AFP338.31ng/ml, HBsAg, anti HBe, anti HBc positive, GPT47U/L, GOT58U/L, blood ammonia 65umol/L. Diagnosis: hepatocellular carcinoma recurrence and multiple metastases after resection of primary liver cancer. Chest X ray films were normal, and no extrahepatic metastasis was found.

1.2 liver transplant in November 14, 2003 undergoing orthotopic liver transplantation (PBLT). The donor was a 26 year old male patient with brain death at the age of 1, with a blood type of "A". The operation lasted for 11 hours, the donor liver cold ischemia time was 8 hours, the warm ischemia time was for about 3 minutes; the anhepatic period was about 87 minutes. Intraoperative bleeding of about 800 ml, infusion of red blood cells of 1200 ml, plasma of 1400 ml, prothrombin complex of 3000 units. Smooth operation. Postoperative pathology: high and middle differentiated nodular hepatocellular carcinoma.

The immune suppression scheme after the 1.3 Bullock complex 3mg capsule orally 2 times / day, oral prednisone tablets 15mg, 1 times / day.

1.4 anti hepatitis B virus program Aciclovir Tablets 0.4 orally 3 times / day, oral lamivudine tablets 100mg 1 times / day, Human Hepatitis B Immunoglobulin 800IU intramuscular injection of 1/ weeks.

After 1.5 40mg oral anticoagulant drugs, aspirin enteric coated tablets 3 times / day, oral dipyridamole tablets 25mg 3 times / day.

1.6 after the removal of T tube and chemotherapy in March after the hospital review, T cholangiography showed patency of the biliary tract, removal of T type biliary drainage tube. Given peripheral intravenous chemotherapy, plan is as follows: the first day of the 5 F-U 0.5g + second day epirubicin mitomycin 8mg; 10mg. No adverse reaction.

1.7 after liver transplantation, the recurrence of liver cancer in was found in the physical examination of the left and right lobe of the liver, and there were about 1 3cm occupying lesions in the liver at the junction of the left and right lobes in the year of June 2005. No tumor was disappeared after radiofrequency ablation in August 2005. The tumor remained after transcatheter arterial chemoembolization in September 2005. In October 20, 2005, ultrasound examination showed that the left internal lobe was 2.8cm * 3.3cm, considering the recurrence of liver cancer. Then in October 24, 2005 in the general anesthesia in the left lobe tumor radiofrequency therapy and partial hepatectomy, liver was observed in normal liver, left lobe diameter is about 3cm of the tumor to the visceral surface prominent, first radiofrequency treatment, then resection. Smooth operation. Postoperative pathology: moderately differentiated hepatocellular carcinoma.

1.8 after liver transplantation, the recurrence of liver cancer in July 10, 2006 was followed by ultrasound in the year of. The results showed that there was a high echo in the right anterior branch of the portal vein and a hypoechoic lesion in the left and right hepatic junction. July 13, 2006 CT: right lobe of the liver low density foci (about 2.2cm size); the liver side lobe suspicious lesions (about 1.0cm), the nature of undetermined; liver and kidney between soft tissue shadow (about 1.0cm), portal vein width; left renal cyst. Treatment of hepatic arterial chemotherapy and embolization in August 1, 2006. August 29, 2006 by abdominal CT showed liver cancer after embolization of the right hepatic lobe, multiple agent lipiodol deposition, compared with 2006-07-13 CT, the right lobe of the liver low density area increased slightly (2.2cm * 2.5cm), liver nodules (about 1.0cm) and the side lobe of liver low density (about 1.0cm) had no obvious change. The September 1, 2006 Review of ultrasound shows: liver transplantation of the right hepatic lobe visible 2 sizes were solid 2.0cm * 1.9cm, 1.6cm * 1.4cm lesions, lesions of liver and kidney clearance of 1 1.4cm visible leaf * 1.0cm right after considering the recurrence of hepatocellular carcinoma. Radiofrequency ablation of right posterior lobe and right anterior lobe tumor in general anesthesia in September 5, 2006. During the operation, there were some 1.1 x 1.2cm occupying lesions in the right posterior lobe of the liver, and the local excision showed that the differentiated hepatocellular carcinoma. B ultrasound examination showed: two cases of the right anterior lobe of the liver were found in the lesions of 1.6 x 1.5cm, 2.1 x 2.2cm. Radiofrequency catheter ablation of 2 lesions in the right anterior lobe of the liver.

2 Results

The patient recovered smoothly after liver transplantation and was discharged 31 days after operation. After discharge the general condition is good, can normal life, work. In 2004, he went to Wuhan to participate in the sports meeting of liver transplant recipients, and won the two prize. After liver transplantation, the patients were treated with anti HBV drugs, anti rejection drugs and anticoagulant drugs for a long time. The HBV HBV-DNA was controlled below 103copies/ml and the liver function was normal. 3 months after the liver transplantation, T type drainage tube was placed in the bile duct and the common bile duct anastomosis. Immediate extraction.

At the nineteenth month after liver transplantation, the new liver cancer recurrence in the transplanted liver was cured by radiofrequency ablation, transcatheter arterial chemoembolization, radiofrequency ablation and surgical resection.

Thirty-second months after liver transplantation, the new liver recurrence of liver cancer recurrence, the same, after transcatheter arterial chemoembolization, radiofrequency ablation, surgical resection, such as comprehensive sequential treatment after recovery, generally in good condition. Since then no recurrence of liver cancer.

5 years after surgery found that portal vein thrombosis, abnormal liver function, ascites, liver protection, anticoagulation and supplemental albumin liver function after treatment of ascites disappeared gradually recovered. Patients with good spirit, food intake, two normal, normal liver function, self-care, regular outdoor activities. Up to now, still alive.

3 discussion

3.1 liver cancer patients with liver transplantation standard after resection of hepatocellular carcinoma 3 years recurrence rate of more than 50%[1]; due to recurrent tumors were multiple and poor liver function, after resection of hepatocellular carcinoma recurrence is still feasible again only a minority of patients with resection of [2], resulting in the role of liver transplantation in the treatment of recurrent hepatocellular carcinoma after growing highlight [3-4].

According to reports, the number and size of tumor recurrence after liver resection with Milan (Milan) standard [5] (single cancer, less than 5cm in diameter; or 2 ~ 3 cancer, diameter less than 3cm; extrahepatic metastasis, portal vein and hepatic vein invasion by image evidence) is liver transplantation with good indication of [3,4]. Milan standard was first proposed by Bismuth, after the Milan Mazzaferro summary and recognized. In 1996, Mazzaferro reported the transplantation of liver patients in line with the standard 4 years after the recurrence rate of less than 10%, after 4 years overall survival rate and disease-free survival rate were 85% and 92%, and more than this standard is only 50% and 59%. Since then, a number of liver transplantation units, such as the application of Milan has been a similar satisfactory results [6-8]. The disease-free survival rate was significantly higher than that of liver resection increasing evidence that conforms to the Milan standard after liver transplantation, but the survival rate and quality of life with benign liver transplantation also satisfactory postoperative, the indicators and the Milan standard is very easy to learn and get the standardized examination technology obtained through the current image, so in 1998, the United States organ distribution network (UNOS) began to use the Milan standard as the basis for the screening of the receptor of liver transplantation, the Milan standard has become the world's most widely used screening criteria for liver transplantation. However, the Milan standard is flawed. First of all, in line with the Milan standard of small hepatocellular carcinoma underwent liver transplantation and liver resection no significant difference in overall survival compared to only the disease-free survival rate was significantly higher than that of the former to the latter, considering the lack of donor and transplant the high cost and other factors, to meet the Milan standard tolerable hepatectomy, whether direct liver transplantation treatment is still a controversial issue, especially in many developing countries especially questioned. Secondly, Milan standard will be a lot of good curative effect by liver transplantation in advanced liver cancer, shut out, although these patients after liver transplantation in 3 or 5 years survival rate may be less than 50%, but from another point of view, the Milan standard made possible through liver transplantation for patients with hepatocellular carcinoma that lost 50% survival the last hope. Milan standard is difficult to be used in the screening of liver transplantation recipients in living donor liver and advanced liver cancer. In addition, the Milan standard does not take into account the chronic liver disease.

In order to overcome the problems of the Milan standards are too strict, Marsh [9] put forward improvement of Pittsburgh TNM standard in 2000 (Table 1): according to the vascular invasion and liver lobe distribution, tumor size, lymph node involvement and distant metastasis of hepatocellular carcinoma will be divided into I, II, III, IV, III A B A, B IV six I ~ III, B meets the criteria for liver transplantation, and IV A and IV B were excluded from liver transplantation outside. This has significantly expanded the scope of liver transplantation for liver cancer, and there may be nearly 50% of hope for long-term survival. But as the biggest defect of liver transplantation for hepatocellular carcinomas is that before surgery is difficult to make an accurate assessment of the microvascular or hepatic branch vascular invasion, and many have chronic hepatitis patients with hepatocellular carcinoma, lymph node enlargement of the liver at the door is likely to be inflammatory, need for intraoperative frozen section to clear. Secondly, because the liver the contradiction between supply and demand is growing, although liver transplantation has expanded the indications that some advanced hepatocellular carcinoma patients may benefit from that, but the overall survival rate was significantly reduced, and thus reduces the possibility for long-term survival of the patients with benign liver disease was liver chance.

Table 1 Pittsburgh standard [9]

by stages

Vascular invasion

Liver lobe involvement

Tumor diameter (CM)

Lymph node involvement

Distant metastasis

Transplantation indication

I

No or microvascular invasion

Unlimited

Less than or equal to 2

nothing

nothing

yes

II

Microvascular invasion

Simple leaf

> 2

nothing

nothing

yes

III A

nothing

Futaba

> 2

nothing

nothing

yes

III B

Microvascular invasion

Futaba

> 2

nothing

nothing

yes

IV A

Vascular invasion

Unlimited

Unlimited

nothing

nothing

no

IV B

Unlimited

Unlimited

Unlimited

Positive *

Positive *

no

* lymph node involvement or distant metastasis in any of the two positive B stage

In 2001 the University of Calif San Francisco Yao [10] proposed the liver transplantation of American California University standard (UCSF standard, University of California, San Francisco criteria), namely: single tumor diameter less than 6.5cm; a small tumor number is less than 3, each tumor diameter less than 4.5cm, the cumulative tumor diameter less than 8.0cm; no intrahepatic blood vessels no extrahepatic metastasis infiltration. Yao analysis of 70 cases of liver transplantation cases, in line with the UCSF standard after 1 and 5 years survival rates were 90% and 75.2%, there was no significant difference with liver transplantation with Milan standard; but beyond the Milan standard with UCSF standard cases of liver transplantation, the 2 year survival rate was 86%. In recent years, the literature supporting the use of UCSF criteria for screening of liver transplantation recipients has increased by [11,12]. Compared with the Milan standard, UCSF standard is significantly reduced due to waiting for liver time increased the receptor loss rate, expand the indications of liver transplantation, the postoperative recurrence rate and no significant increase, showing better than the Milan standard reference value.

The standard [13] of Kyoto University in Japan is: the patients are not suitable for liver resection, exclude the extrahepatic metastasis or large blood vessel infiltration, not limited to the number and size of tumor. This standard is a liver transplantation provider based on a strong wish to save the family life and make, it meets some advanced liver cancer patients survival desire, different degrees according to the standard of living donor liver transplants performed in patients with advanced hepatocellular carcinoma can prolong the life of these patients. However, this standard has no guiding significance for routine cadaveric liver transplantation.

As the world's highest incidence of liver cancer in the world, each year more than half of the world's new liver cancer in China [14], therefore, the country is also summarized in line with China's national conditions to explore the criteria for liver transplantation.

Fan Jia in 2006 proposed the Shanghai Fudan criteria: [15] single tumor diameter less than 9cm, or multiple tumors less than 3 and the maximum tumor diameter less than 5cm, the sum of all the tumor diameter less than 9cm, no major vascular invasion, lymph node metastasis and liver metastasis. It is reported to comply with this standard in 151 cases (60.2%), postoperative 1, 2, 3 year overall survival and disease-free survival rates were 88%, 80%, 80% and 90%, 88%, 88%, is beyond the standard case (n =100; 77%, 44%, 20%, 63%, and 64% 63%) there were significant differences (P& lt; 0.01) [16]. Shanghai Fudan standard and Milan standard, UCSF standard 3 year overall survival rate, disease-free survival rate and recurrence rate was no significant difference (P> 0.05), but increased significantly in group of cases. In line with the Shanghai Fudan criteria but exceeded the standard Milan case and conforms to the Milan standard cases of postoperative survival rate and disease-free survival rate showed no significant difference (P > 0.05).

The First Affiliated Hospital of Medical College of Zhejiang University academician Zheng Shusen with 10 years of liver transplantation practice proposed a new "Hangzhou standard" [17,18]: no tumor vascular invasion and liver metastasis; all tumor nodules diameter and not more than 8 cm, or diameter of tumor nodules and greater than 8 cm, but the preoperative serum alpha fetoprotein (AFP) levels less than 400ng/ml and tumor histological grade was high or middle differentiation, other indexes can meet the requirements of liver transplantation. Hangzhou's standards in 99 cases after 1, 3, 5 year survival rate was 92.8%, 70.7%, 70.7%, the disease-free survival rate was 83.7%, 65.6%, 62.4%, in line with the Milan standard 72 cases after 1, 3, 5 year survival rate was 94.3%, 78.3%, 78.3%, 1, 3, 5 years the disease-free survival rate was 87.3%, 74%, 69.7%, in line with the Hangzhou criteria and Milan in patients with postoperative survival rate and disease-free survival rate were not statistically significant [19]. However, the 96 patients beyond the Hangzhou criteria were significantly higher than those in the Hangzhou standard group, with a significant difference of 49.9%, 27%, 18.9% and 25.8%, 12.5%, respectively. Compared with the Milan standard, the number of cases in Hangzhou was increased by 37.5%, and the tumor free survival rate was [19]. The Hangzhou standard exceeds the Milan standard and the UCSF standard in terms of the size of the tumor, and more importantly, the introduction of two important biological characteristics of liver cancer: histopathological grade and serum AFP levels. Hangzhou has expanded the Milan standard safely, so that more patients with liver cancer can receive liver transplantation, and achieved a similar long-term survival rate with the Milan standard [19].

The Hangzhou Standard Practice of domestic transplant center, confirmed that it does not reduce the postoperative survival rate and disease-free survival rate, effectively expanding the indications of liver transplantation for hepatocellular carcinoma, HCC can make more patients benefit from liver transplantation, more in line with the current situation of our country [19].

Retrospective analysis of recurrent tumor resection in patients with hepatocellular carcinoma after both the number of (multiple) and size (1.0~6.5cm) are more than Milan and California University of American standard standard, but also beyond the later domestic standards in Shanghai, but then announced Chinese completely conforms to the standard of Hangzhou (AFP338.31ng/ml, the high and middle differentiated). The patient has survived for 7 years after liver transplantation, and the tumor free survival after transplantation is about 19 months. In this case, the results of liver transplantation in patients with liver cirrhosis confirmed the advantages of the Hangzhou standard of liver transplantation is very consistent with the actual situation of liver transplantation in patients with liver cancer, and satisfactory results.

3.2 patients with recurrent liver cancer in the perioperative period of sequential therapy because of the limited source of donor liver, most liver transplant patients have to wait for a period of time. Once more than 6 months, the development of the tumor is likely to lose the chance of liver transplantation [20]. In order to control the growth of the tumor in the liver during the period of treatment, the patient should be treated with hepatic arterial chemoembolization (TACE) every 6 to 8 weeks, until the tumor completely necrosis or wait until the donor organ [21]. It is suggested that TACE may even cause injury of hepatic artery, hepatic artery occlusion, increase graft difficulty, but it seems that preoperative TACE as long as the attention can not damage the hepatic artery embolization with micro catheter implementation on vascular distortion of patients, will not damage the hepatic artery. There are also claims to be used in the process of liver transplantation before chemotherapy, TACE, percutaneous ethanol injection (percutaneous ethanol, injection, PEI), radiofrequency ablation (radiof requency ablation, RFA) and other comprehensive sequential treatment of [22-24]. In the process of waiting for transplantation, liver resection can effectively control the development of liver cancer and make the liver transplantation to obtain better curative effect [25]. In cases with tumor free technique [26,27]: first from all broken structure in the hepatoduodenal ligament, including bile duct, hepatic artery and portal vein, then in the second hepatic hilum severed 3 hepatic veins, and then fully free liver vascular occlusion of the liver in the main entry after the separation of short hepatic vessels and the liver after the inferior vena cava, resection of liver disease, it is possible to reduce the operation lead to liver cancer transfer opportunities, reduce the recurrence rate of HCC; tumor in the liver surface, protect the wound should be open; the operation should be gentle, to avoid excessive squeeze and repeatedly moving the liver tumors; liver tumor especially with surface rupture, should be properly used the gauze wrapped tumor; tumor adhesion to surrounding organs, such as diaphragm, omentum and gastrointestinal, should remove part of adhesion organization, or use the electric knife or argon knife burning invasion surgery wound; Wash the wound with distilled water before the end of one side of the portal vein branch ligation; pre or portal vein; vein chemotherapy also can reduce the postoperative recurrence of [28]. The patients before liver transplantation after resection for recurrent hepatocellular carcinoma has been adopted in TACE, PEI and other comprehensive treatment, the liver cancer can be effectively controlled, transplanted from recurrence after resection of hepatocellular carcinoma to the liver, liver patients to time up to 2 and a half years, a satisfactory effect is still to be seen after transplantation, sequential treatment for recurrence in the process of liver cancer liver is essential and effective. After liver transplantation, systemic chemotherapy was given in the short term (within 3 months), which also played an important role in preventing recurrence of HCC after transplantation [22,28].

3.3 HCC recurrence after liver transplantation treatment after liver transplantation once relapse, still advocate the use of sequential comprehensive individualized treatment [27]:TACE for multiple liver cancer treatment [29], PEI for less than 3cm of recurrent hepatocellular carcinoma, recurrent tumor RFA and cryoablation for less than 5cm. Postoperative systemic chemotherapy is a safe and effective treatment [30]. Recently, it has been reported that second or even third hepatectomy for patients with recurrent hepatocellular carcinoma (HCC) can achieve satisfactory results [2,31], which is significantly better than other adjuvant therapy [4]. The patients although the occurrence of HCC recurrence after transplantation respectively in 19 and 32 months, but after resection of 2 comprehensive treatment and after surgery were cured, second surgery has been disease-free survival for 3 years 7 months. The cases of liver transplantation in patients with recurrent liver cancer successfully cured, that is necessary and beneficial to the comprehensive treatment of liver cancer recurrence after transplantation of individualized, comprehensive treatment should be with surgery, reduce the diffusion for the main purpose. There are claims on the transplantation of patients with recurrent HCC after liver transplantation performed again, but we believe we should first combine their experience with surgical operations, it is possible to get the cure and achieved satisfactory results, two cases of liver transplantation should be very cautious.

In short, the cases of successful treatment experience, we think: in accordance with the actual situation of Chinese liver transplantation Hangzhou standard, can be used as screening criteria for liver transplantation in patients with recurrent hepatocellular carcinoma after operation; peri operative sequential comprehensive individualized treatment is essential for liver transplantation in patients with liver transplantation; recurrence of hepatocellular carcinoma after use surgical resection of the individualized treatment of recurrent hepatocellular carcinoma after liver transplantation is still possible to cure liver retransplantation should be very cautious.

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