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Resection of NAFLD-Associated HCC: Patient Selection and Reported Outcomes

Authors Campani C, Bensi C, Milani S, Galli A, Tarocchi M

Received 2 May 2020

Accepted for publication 10 July 2020

Published 30 July 2020 Volume 2020:7 Pages 107—116

DOI https://doi.org/10.2147/JHC.S252506

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Ahmed Kaseb


Claudia Campani,* Carolina Bensi,* Stefano Milani, Andrea Galli, Mirko Tarocchi

Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy

*These authors contributed equally to this work

Correspondence: Mirko Tarocchi
Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Morgagni 50, Florence, Italy
Tel +39 0552758115
Email mirko.tarocchi@unifi.it

Abstract: Global prevalence of non-alcoholic fatty liver disease (NAFLD) has been growing in the last decades, especially in western countries, due to increased prevalence of diabetes, obesity or other components of metabolic syndrome. NAFLD recently became an important cause of hepatocellular carcinoma (HCC), even in non-cirrhotic patients. Patients with HCC-NAFLD are usually older, with more morbidities (especially cardiovascular diseases and metabolic disorders) and have advanced disease at the diagnosis due to the absence of surveillance, which is considered not cost-effective in patients without advanced fibrosis/cirrhosis, given the large prevalence of NAFLD in the general population. For these reasons, patients with HCC-NAFLD unlikely underwent curative treatments, and have been reported to have lower overall survival (OS) compared to individuals with HCC related to other aetiologies. However, this difference is not confirmed by data of patient subgroups who received curative treatment. In our review, we selected studies published over the past 8 years that analyse characteristics and outcomes of HCC-NAFLD patients who underwent surgery with the aim of identifying features that could predict outcomes and potential selection criteria. All the studies confirm that patients with HCC-NAFLD are older, with many comorbidities and that HCC occurs frequently even in non-cirrhotic livers. There is no agreement about intraoperative and perioperative complications. Regarding outcomes, all papers agree that patients with HCC in NAFLD who undergo surgery have a better OS compared to other aetiologies. Summarizing, surgery is a good curative option for patients with HCC-NAFLD, perhaps even better than transplantation in terms of OS. In this group of patients, it seems to be essential to evaluate cardio-pulmonary and general operative risk, in addition to the normal risk assessment related to liver function to avoid an underestimation, especially for patients without severe underlying fibrosis.

Keywords: hepatocellular carcinoma, non-alcoholic fatty liver disease, surgery

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