PTU-004 Hepatocellular carcinoma can be managed safely and effectively in a DGH-setting with superior surveillance-programme survival

Autor: Earl J. Williams, Muhammad Asad, Matthew Stammers, Andrew Shawyer, Clare Bent, S Al-Shamma
Rok vydání: 2019
Předmět:
Zdroj: Posters.
DOI: 10.1136/gutjnl-2019-bsgabstracts.213
Popis: Introduction and aims HCC is the second commonest cause of cancer-related death worldwide and strongly associated with liver cirrhosis and with a rising incidence. Despite screening most HCC cases present at an intermediate or advanced stage unsuitable for curative surgery. The standard of care for most non-curative cases being actively treated remains transarterial chemo-embolisation TACE and/or ablation (RFA.) Both are specialist procedures normally delivered in tertiary centres. At the Royal Bournemouth Hospital (RBH), a large DGH, specialist HCC treatments are offered to Dorset County following MDT and combined hepatology/IR clinic review. There is an established surveillance programme offered to all suitable at-risk patients. We sought to assess the outcomes of the service with a focus on the benefits of surveillance and the safety of offering tertiary level services in a DGH setting. Methods We identified all new HCC cases presented in the pan-Dorset Upper GI MDT from Jan 2017 to Dec 2017. We collected demographic data, whether they had been under a surveillance programme and the treatment outcomes including complications and 1- and 12- month mortality. Results We identified 35 patients (30 M; 5F.) The aetiology was alcohol in 26% (n=9), NASH 43% (n=15), HCV 17% (n=6) and others 9% (n=3.) Cirrhosis was present in 63% (n=22): Child’s A 59% (n=13), Child’s B 32% (n=7) & Child’s C 9% (n=2.) Most cases were referred from RBH 77% (n=27), and 23% from the two other referring hospitals in the County. HCC surveillance detected 43% (n=15) of cases with 57% new presentations. Of the surveillance cases, the majority 87% (n=13) were identified at the centre with the most established surveillance programme but as the largest centre RBH also identified most new presentations 70% (n=14.) More active treatment was offered to the surveillance group at 87% vs 65% of non-surveillance group (p≤0.05.) Curative treatment (transplant, surgery or RFA to small HCC) was suitable in only 14.3% (n=5), all identified by surveillance. TACE was offered to 46% of patients (n=16.) Of the TACE patients, 56% (n= 9) underwent more than 1 procedure. Only 2 patients had decompensation post-TACE, which recovered. Post-TACE survival was 100% at 1 month and 79% at 1 year. These outcomes are comparable to published literature from larger centres. Overall 1-month and 12-month survival for surveillance cases was better than new presentations at 100% and 73% vs 85% and 50% respectively (p≤0.05.) Conclusions Specialist HCC treatment, following combined hepatology/IR review, can be offered safely and effectively in a large DGH setting with mortality and morbidities outcomes comparable to specialist tertiary centres. Our data confirms HCC surveillance allows for earlier cancer detection with more treatment options and improved survival.
Databáze: OpenAIRE