Sponsored: Human albumin: Focus on liver disease - Page 10

adjuvant therapy as yet . Postoperative preventive transarterial chemoembolisation ( TACE ) can delay recurrence and prolong survival of patients at high risk of recurrence . 10 Therefore , routine TACE is recommended in the Chinese Society of Clinical Oncology guideline for patients with residual lesions , multiple nodules , for tumours > 5cm diameter , and vascular invasion . 11
Retrospective studies have shown that sorafenib is useful as a postoperative adjuvant therapy for patients at a high risk of recurrence ; 11 however , different conclusions were drawn from the Phase III STORM study . 12 Nevertheless , nearly 50 % of patients included in the study had a single tumour without microvascular invasion and were at a lower risk of metastasis and recurrence . Therefore , the value of the targeted drug as a postoperative adjuvant therapy cannot be denied on the basis of the negative results in the STORM study alone .
Neoadjuvant therapies include TACE , targeted therapy , and immunotherapy , each of which can be used alone or in combination . At present , there is no definitive evidence that preoperative TACE improves the prognosis of patients who underwent resection . Therefore , preoperative TACE for a single , solitary large liver tumour is not recommended in the guidelines . However , for patients who achieved pathological response after TACE , TACE combined with surgery can significantly improve their prognosis than surgery alone . 13 15 The significance of
TACE combined with the targeted drugs , lenvatinib and anlotinib , as neoadjuvant therapy was explored in the LEAP-012 and ALTER-H-004 studies , and the 16 , 17 results eagerly awaited .
Perioperative human albumin The liver synthesises albumin and is the unique source of endogenous albumin . 18 Liver cancer and liver-related lesions greatly decrease the ability to synthesise albumin . In addition , serum albumin levels in patients who undergo surgical treatment are lowered owing to bleeding and increased vascular permeability due to postoperative tissue trauma , which causes albumin to leak into tissue fluid .
The preoperative level of serum albumin is considered an important indicator of postoperative prognosis in liver cancer patients . Intra-abdominal infection is a fatal complication after hepatectomy , with an incidence of about 17 % and mortality of 15.7 %. Results of a retrospective study showed that the incidence of postoperative intra-abdominal infection was significantly higher in those with preoperative serum albumin < 35g / l than those with serum levels ≥35g / l ( 22.73 % vs 9.83 %, p < 0.005 ). 19 Similarly , the preoperative serum albumin level can be used to predict long-term prognoses of patients undergoing hepatectomy . A study conducted in patients with intrahepatic cholangiocarcinoma who underwent hepatectomy showed that diseasefree survival and overall survival of those with
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