Hepatectomy After Conversion Therapy for Initially Unresectable HCC: What is the Difference?

Area of Science:

• Hepatobiliary surgery
• Oncology
• Gastroenterology

Background:

• Hepatocellular carcinoma (HCC) is a primary liver cancer.
• Unresectable HCC poses treatment challenges.
• Conversion therapy aims to downstage tumors for surgical resection.

Purpose of the Study:

• To evaluate the safety and efficacy of hepatectomy following conversion therapy for unresectable HCC.
• To compare outcomes of hepatectomy after conversion therapy versus direct hepatectomy.

Main Methods:

• Retrospective study of 745 HCC patients undergoing hepatectomy (January 2018 - April 2022).
• 41 patients with unresectable HCC received conversion therapy before hepatectomy.
• Propensity score matching created a comparable control group for direct hepatectomy.

Main Results:

• Conversion therapy (median 108 days) achieved responses in 8/41 (complete) and 33/41 (partial).
• The conversion group experienced higher blood loss, longer operative time, more transfusions, and longer hospital stays.
• Complication rates were significantly higher in the conversion group (82.9% any grade, 26.8% grade 3/4), including 6 cases of post-hepatectomy liver failure (PHLF).
• All patients achieved R0 resection; 14.6% achieved pathological complete response (pCR).
• Median follow-up of 12.8 months showed recurrence/metastasis in 14 conversion group patients, with no deaths in either group.

Conclusions:

• Hepatectomy after conversion therapy is feasible but technically more demanding than direct hepatectomy.
• Close preoperative assessment is crucial for surgical safety.
• Conversion therapy can cause significant liver function impairment; PHLF prevention and management are critical.
• Postoperative pathological findings guide adjuvant therapy decisions.