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Cancers
Special Issues
Selecting the Best Approach for Single and Multiple Liver Tumors
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Selecting the Best Approach for Single and Multiple Liver Tumors

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (15 April 2023) | Viewed by 12382

Special Issue Editors

Prof. Dr. Ho-Seong Han

E-Mail Website
Guest Editor
Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea
Interests: liver resection; hepatocellular carcinoma
Dr. Gianluca Cassese

E-Mail Website
Guest Editor
Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea
Interests: liver resection; hepatocellular carcinoma; colorectal liver metastases

Special Issue Information

Dear Colleagues,

Liver surgery is considered the cornerstone treatment for hepatocellular carcinoma and colorectal liver metastases. Since the first laparoscopic liver resection, reported in 1991, its uptake has been slow. However, there is still a place for open liver resection, especially for some particular and challenging situations, linked to tumor size, number and location. Furthermore, there is the need for performing more complex procedures than for other pathologies, such as anatomical liver resections for HCC or parenchymal-sparing surgery for CRLM. It is important for all liver surgeons to know which is the best approach in these variable conditions.

We are pleased to invite the submission of articles concerning the advantages and drawbacks of the different possible approaches for the aforementioned liver tumors, including anatomical and parenchymal-sparing hepatectomy, as well as open and minimally invasive approaches, with particular emphasis on challenging situations.

The aim of this Special Issue is to provide a platform for all current evidence and knowledge relevant to selecting the best approaches for liver tumors when dealing with single or multiple HCC and CRLM.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

  • Selecting the best approach for single HCC;
  • Selecting the best approach for multiple HCC;
  • Selecting the best approach for single CRLM;
  • Selecting the best approach for multiple CRLM.

We look forward to receiving your contributions.

Prof. Dr. Ho-Seong Han 
Dr. Gianluca Cassese
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hepatocellular carcinoma
  • colorectal liver metastases
  • anatomical liver resection
  • parenchyma sparing hepatectomy
  • liver resection

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Published Papers (5 papers)

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Research

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13 pages, 1317 KiB  
Article
Upfront Surgery versus Neoadjuvant Perioperative Chemotherapy for Resectable Colorectal Liver Metastases: A Machine-Learning Decision Tree to Identify the Best Potential Candidates under a Parenchyma-Sparing Policy
by Simone Famularo, Flavio Milana, Matteo Cimino, Eloisa Franchi, Mario Giuffrida, Guido Costa, Fabio Procopio, Matteo Donadon and Guido Torzilli
Cancers 2023, 15(3), 613; https://doi.org/10.3390/cancers15030613 - 18 Jan 2023
Cited by 8 | Viewed by 2061
Abstract
Addressing patients to neoadjuvant systemic chemotherapy followed by surgery rather than surgical resection upfront is controversial in the case of resectable colorectal –liver metastases (CLM). The aim of this study was to develop a machine-learning model to identify the best potential candidates for [...] Read more.
Addressing patients to neoadjuvant systemic chemotherapy followed by surgery rather than surgical resection upfront is controversial in the case of resectable colorectal –liver metastases (CLM). The aim of this study was to develop a machine-learning model to identify the best potential candidates for upfront surgery (UPS) versus neoadjuvant perioperative chemotherapy followed by surgery (NEOS). Patients at first liver resection for CLM were consecutively enrolled and collected into two groups, regardless of whether they had UPS or NEOS. An inverse –probability weighting (IPW) was performed to weight baseline differences; survival analyses; and risk predictions were estimated. A mortality risk model was built by Random-Forest (RF) to assess the best –potential treatment (BPT) for each patient. The characteristics of BPT-upfront and BPT-neoadjuvant candidates were automatically identified after developing a classification –and –regression tree (CART). A total of 448 patients were enrolled between 2008 and 2020: 95 UPS and 353 NEOS. After IPW, two balanced pseudo-populations were obtained: UPS = 432 and NEOS = 440. Neoadjuvant therapy did not significantly affect the risk of mortality (HR 1.44, 95% CI: 0.95–2.17, p = 0.07). A mortality prediction model was fitted by RF. The BPT was NEOS for 364 patients and UPS for 84. At CART, planning R1vasc surgery was the main factor determining the best candidates for NEOS and UPS, followed by primitive tumor localization, number of metastases, sex, and pre-operative CEA. Based on these results, a decision three was developed. The proposed treatment algorithm allows for better allocation according to the patient’s tailored risk of mortality. Full article
(This article belongs to the Special Issue Selecting the Best Approach for Single and Multiple Liver Tumors)
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Review

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14 pages, 824 KiB  
Review
Systemic Neoadjuvant and Adjuvant Therapies in the Management of Hepatocellular Carcinoma—A Narrative Review
by Shadi Chamseddine, Michael LaPelusa and Ahmed Omar Kaseb
Cancers 2023, 15(13), 3508; https://doi.org/10.3390/cancers15133508 - 5 Jul 2023
Cited by 9 | Viewed by 2800
Abstract
The burden of hepatocellular carcinoma (HCC) continues to pose a significant global health problem. Several systemic therapies have recently been shown to improve survival for patients with unresectable disease. However, evidence to support the use of neoadjuvant or adjuvant systemic therapies in patients [...] Read more.
The burden of hepatocellular carcinoma (HCC) continues to pose a significant global health problem. Several systemic therapies have recently been shown to improve survival for patients with unresectable disease. However, evidence to support the use of neoadjuvant or adjuvant systemic therapies in patients with resectable disease is limited, despite the high risk of recurrence. Neoadjuvant and adjuvant systemic therapies are being investigated for their potential to reduce recurrence after resection and improve overall survival. Our review identified various early-phase clinical trials showing impressive preliminary signals of pathologic complete response in resectable disease, and others suggesting that neoadjuvant therapies—particularly when combined with adjuvant strategies—may convert unresectable disease to resectable disease and cause significant tumor necrosis, potentially decreasing recurrence rates. The role of adjuvant therapies alone may also play a part in the management of these patients, particularly in reducing recurrence rates. Heterogeneity in trial design, therapies used, patient selection, and a scarcity of randomized phase III trials necessitate the cautious implementation of these treatment strategies. Future research is required to identify predictive biomarkers, optimize the timing and type of therapeutic combinations, and minimize treatment-related adverse effects, thereby personalizing and enhancing treatment strategies for patients with resectable and borderline resectable HCC. Full article
(This article belongs to the Special Issue Selecting the Best Approach for Single and Multiple Liver Tumors)
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19 pages, 374 KiB  
Review
Outcomes and Patient Selection in Laparoscopic vs. Open Liver Resection for HCC and Colorectal Cancer Liver Metastasis
by Jurgis Alvikas, Winifred Lo, Samer Tohme and David A. Geller
Cancers 2023, 15(4), 1179; https://doi.org/10.3390/cancers15041179 - 12 Feb 2023
Cited by 7 | Viewed by 2594
Abstract
Hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) are the two most common malignant tumors that require liver resection. While liver transplantation is the best treatment for HCC, organ shortages and high costs limit the availability of this option for many patients and [...] Read more.
Hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) are the two most common malignant tumors that require liver resection. While liver transplantation is the best treatment for HCC, organ shortages and high costs limit the availability of this option for many patients and make resection the mainstay of treatment. For patients with CRLM, surgical resection with negative margins is the only potentially curative option. Over the last two decades, laparoscopic liver resection (LLR) has been increasingly adopted for the resection of a variety of tumors and was found to have similar long-term outcomes compared to open liver resection (OLR) while offering the benefits of improved short-term outcomes. In this review, we discuss the current literature on the outcomes of LLR vs. OLR for patients with HCC and CRLM. Although the use of LLR for HCC and CRLM is increasing, it is not appropriate for all patients. We describe an approach to selecting patients best-suited for LLR. The four common difficulty-scoring systems for LLR are summarized. Additionally, we review the current evidence behind the emerging robotically assisted liver resection technology. Full article
(This article belongs to the Special Issue Selecting the Best Approach for Single and Multiple Liver Tumors)
10 pages, 1364 KiB  
Review
Laparoscopic Repeat Liver Resection—Selecting the Best Approach for Repeat Liver Resection
by Zenichi Morise, Hidetoshi Katsuno, Kenji Kikuchi, Tomoyoshi Endo, Kazuhiro Matsuo, Yukio Asano and Akihiko Horiguchi
Cancers 2023, 15(2), 421; https://doi.org/10.3390/cancers15020421 - 9 Jan 2023
Cited by 2 | Viewed by 1972
Abstract
Recurrence of liver cancers after liver resection (LR), such as recurrences of hepatocellular carcinoma and colorectal liver metastases, is often treated with repeat LR (RLR) as the only curative treatment. However, RLR is associated with an increased risk of complications. The indications for [...] Read more.
Recurrence of liver cancers after liver resection (LR), such as recurrences of hepatocellular carcinoma and colorectal liver metastases, is often treated with repeat LR (RLR) as the only curative treatment. However, RLR is associated with an increased risk of complications. The indications for the currently emerging laparoscopic LR and its advantages and disadvantages for repeat treatment are still under discussion. Our multi-institutional propensity-score matched analyses of laparoscopic vs. open RLRs for hepatocellular carcinoma showed the feasibility of laparoscopic RLR with comparable short- and long-term outcomes. Small blood loss and low morbidity was observed in selected patients treated using laparoscopic RLR in which total adhesiolysis can be dodged, with speculations that laparoscopic minor repeated LR can minimize functional deterioration of the liver. However, there are several disadvantages, such as easily occurring disorientation and difficulty in repeated wide-range dissection of Glissonian pedicles. Recently emerging small anatomical resection, indocyanine green fluorescence-guided surgery, and robot-assisted surgery are promising tools for the further development of laparoscopic RLR. This review discusses how laparoscopic RLR, as a powerful unique local therapy causing less damage to the residual liver and surrounding structures, could contribute to the outcomes of repeated treatments for cancers and its future perspectives. Full article
(This article belongs to the Special Issue Selecting the Best Approach for Single and Multiple Liver Tumors)
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15 pages, 631 KiB  
Review
Selecting the Best Approach for the Treatment of Multiple Non-Metastatic Hepatocellular Carcinoma
by Gianluca Cassese, Ho-Seong Han, Jai Young Cho, Hae-Won Lee, Boram Lee and Roberto Ivan Troisi
Cancers 2022, 14(23), 5997; https://doi.org/10.3390/cancers14235997 - 5 Dec 2022
Cited by 8 | Viewed by 2383
Abstract
According to the Barcelona Clinic Liver Cancer (BCLC) staging system, the optimal strategy for patients with multiple HCC within the Milan Criteria is liver transplantation (LT). However, LT cannot be offered to all the patients due to organ shortages and long waiting lists, [...] Read more.
According to the Barcelona Clinic Liver Cancer (BCLC) staging system, the optimal strategy for patients with multiple HCC within the Milan Criteria is liver transplantation (LT). However, LT cannot be offered to all the patients due to organ shortages and long waiting lists, as well as because of the advanced disease carrying a high risk of poor outcomes. For early stages, liver resection (LR) or thermal ablation (TA) can be proposed, while trans-arterial chemoembolization (TACE) still remains the treatment of choice for intermediate stages (BCLC-B). Asian guidelines and the National Comprehensive Cancer Network suggest LR for resectable multinodular HCCs, even beyond Milan criteria. In this scenario, a growing body of evidence shows better outcomes after surgical resection when compared with TACE. Trans-arterial radioembolization (TARE) and stereotaxic body radiation therapy (SBRT) can also play an important role in this setting. Furthermore, the role of minimally invasive liver surgery (MILS) specifically for patients with multiple HCC is still not clear. This review aims to summarize current knowledge about the best therapeutical strategy for multiple HCC while focusing on the role of minimally invasive surgery and on the most attractive future perspectives. Full article
(This article belongs to the Special Issue Selecting the Best Approach for Single and Multiple Liver Tumors)
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