Sponsored: Human albumin: Focus on liver disease - Page 11

preoperative serum albumin levels ≤4.2g / dl were significantly reduced compared with patients with levels > 4.2g / dl . 20
Low serum albumin after hepatectomy is also an important predictive factor . For liver transplantation donors with normal liver function , the risk of postoperative pleural effusion increased by 69 % in those with minimum serum albumin of ≤3.0g / dl on day 2 after hepatectomy compared with those whose levels were > 3.0g / dl . 21 Another retrospective analysis included 998 patients who underwent living donor liver transplantation . Mortality was significantly higher and the length of stay in the ICU was longer in those having postoperative serum albumin of < 3.0g / dl than for those with levels ≥3.0g / dl . In addition , the mortality was associated with increased incidence of acute renal injury . 22
Evidence for the clinical benefit of perioperative human albumin infusion in hepatectomy and liver transplantation has accumulated . Human albumin infusion in liver transplant donors during hepatectomy can increase serum albumin levels 2 days after surgery and significantly reduces the incidence of postoperative pleural effusion . 21 Moreover , as a major contributor to plasma colloid osmotic pressure , timely infusion of human albumin after operation is conducive to perfusion of important organs and maintenance of functions . A retrospective analysis showed that postoperative multi-organ SOFA score decreased significantly in patients who received human albumin infusion after orthotopic liver transplantation compared with the control group . 23
Perioperative use of human albumin in hepatectomy is recommended in the Expert Consensus on Perioperative Management of Hepatectomy ( 2017 edn ). 24 Use of human albumin in the perioperative period prevents postoperative hypoproteinaemia effectively and promotes postoperative recovery ( evidence level III B ). 24 Additionally , the Chinese Expert Consensus on Enhanced Recovery after Hepatectomy states for patients with underlying diseases such as cirrhosis and portal hypertension that , “ a variety of methods can be adopted rationally after hepatectomy to prevent and treat ascites , including controlled fluid replacement , albumin infusion to increase colloid osmotic pressure , low-dose diuretics and terlipressin ( evidence level : intermediate , recommendation level : strong recommendation )’’. 25
However , certain aspects of the clinical application of human albumin in liver cancer , such as exact infusion times , infusion dose , and treatment goals based on evaluable and quantifiable indicators in the perioperative period , need to be explored further and clarified in robust randomised , controlled trials in the future .
Postoperative follow-up strategy Patients can be classified as at a high risk of recurrence and a low risk of recurrence based on preoperative clinical data , intraoperative condition and postoperative pathology . Patients at a high risk of recurrence include those having : visual vascular / bile duct cancer embolus ; low differentiation ; satellite nodules ; multiple tumours ; and microvascular invasion . Patients should receive follow-up every 3 months within the first 2 years of surgery and every 6 months thereafter . Follow-up includes imaging , blood
6 , 26 , 27 tests and tumour marker tests .
Other treatments Although surgery is the basis of treatment of earlystage liver cancer , not all patients have surgical indications . Local ablation is an important treatment choice for these patients . RFA and microwave ablation ( MWA ) are preferred . RFA has a ‘ heat sink effect ’, which can be effectively solved by MWA . In addition , MWA has the advantage of a high ablation rate , so this method is used most commonly in China . 11
Conclusion Surgical treatment is vital for early-stage liver cancer . However , how to further optimise treatment benefit needs to be clarified , for example , through adjuvant / neoadjuvant treatment regimens and clearer guidance on perioperative albumin treatment .
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