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Surgical Resections for Hepatocellular Carcinomas Arising From Fontan-Associated Liver Disease; Open, Laparoscopic
Takashi Motomura1, Shinji Itoh1, Takeo Toshima1
1Department of Surgery and Sciences, Graduate School of Medicine, Kyushu University, Fukuoka, Japan.
Insights
Surgical resection for Fontan-associated liver disease-hepatocellular carcinoma (FALD-HCC) shows comparable long-term outcomes to non-FALD HCC. Early detection through post-Fontan surveillance is crucial for favorable outcomes in FALD-HCC patients.
Area of Science:
- Hepatobiliary surgery
- Oncology
- Cardiology
Background:
- Fontan circulation complications, particularly Fontan-associated liver disease (FALD), are increasingly recognized.
- Hepatocellular carcinoma (HCC) in FALD patients (FALD-HCC) requires further investigation.
- Understanding FALD-HCC is critical for improving patient management.
Purpose of the Study:
- To compare short- and long-term outcomes of liver resections for FALD-HCC versus non-FALD HCC.
- To identify factors influencing outcomes in FALD-HCC surgical treatment.
- To evaluate the role of surveillance in FALD-HCC management.
Main Methods:
- Retrospective review of 12 liver resections for FALD-HCC in 9 patients (2018-present).
- Comparison of FALD-HCC cases with 216 non-FALD HCC resection cases.
- Analysis of surgical approaches, patient demographics, tumor characteristics, intraoperative data, and survival outcomes.
Main Results:
- FALD-HCC patients were younger (37 vs. 69 years) with lower BMI and more advanced fibrosis.
- Greater intraoperative blood loss was observed in the FALD group (1695 vs. 520 mL).
- Recurrence-free survival did not differ significantly between FALD-HCC and non-FALD HCC groups.
Conclusions:
- Long-term outcomes for FALD-HCC surgical resection appear comparable to non-FALD HCC.
- Surgical resection, including minimally invasive options, may be suitable for select FALD-HCC cases (≤2 cm, superficial tumors, CVP ≤12 mmHg).
- Regular post-Fontan surveillance is vital for early FALD-HCC detection and potentially better outcomes.
Background:
Complications associated with the Fontan circulation have become evident in recent years. Fontan-associated liver disease (FALD) has attracted particular attention. However, many aspects of this condition including FALD-associated hepatocellular carcinoma (FALD-HCC) remain unclear.
Patients And Methods:
Since 2018, 12 liver resections for FALD-HCC were performed in 9 patients at our institution. These 12 procedures were reviewed, and 9 cases of primary HCC were compared with 216 cases of primary HCC resection performed during the same period in non-FALD patients in terms of short- and long-term outcomes.
Results:
Among 12, nine were initial and three were recurrences. Approaches included open (n = 6), laparoscopic (n = 4), and robotic surgery (n = 2). Compared with non-FALD patients, FALD group was younger (37 vs. 69 years, p < 0.0001), had lower BMI (19.0 vs. 24.1, p = 0.0002) and showed advanced fibrosis/cirrhosis (F3-4) more frequently (p = 0.03). Intraoperative blood loss was greater in the FALD group (1695 vs. 520 mL, p = 0.0003). Factors associated with blood loss > 1000 mL included CVP > 12 mmHg, tumor size > 2 cm, tumor depth > 3 cm from the liver surface. Among nine patients under regular post-Fontan imaging surveillance, tumors tended to be smaller and blood loss lower. With a mean follow-up period of 32.1 months in the FALD group, recurrence-free survival did not differ between the groups.
Conclusion:
Long-term outcomes seem comparable between FALD and non-FALD HCC. In particular, FALD-HCC ≤ 2 cm and close to the liver surface with CVP ≤ 12 mmHg could be potential candidates for surgical resection, including minimally invasive approaches. Post-Fontan surveillance may be crucial.
