Premium
Hepatocellular carcinoma after Fontan surgery: A systematic review
Author(s) -
Rodriguez De Santiago Enrique,
Téllez Luis,
Guerrero Antonio,
Albillos Agustín
Publication year - 2021
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13582
Subject(s) - medicine , hepatocellular carcinoma , cirrhosis , liver biopsy , biopsy , stage (stratigraphy) , surgery , cohort , radiology , paleontology , biology
Aim Fontan surgery is often the procedure of choice for patients with congenital single effective ventricle. In the long term, elevated systemic venous pressure and chronic ischemia following this procedure could lead to advanced chronic liver disease and there is also a risk of hepatocellular carcinoma (HCC). This review systematically summarizes the characteristics and outcomes of this rare condition. Methods PubMed and Embase databases were searched from inception to January 2020 for studies reporting on HCC after Fontan surgery. The factors analyzed were clinical presentation, histology, imaging findings, treatments, and survival. Our primary analysis was based on biopsy‐proven HCC. Results The records selected were 26 observational studies (19 case reports/case series and seven cohort studies) including 65 biopsy‐proven HCC. Age at the time of HCC diagnosis ranged from 12 to 52 years, and 62% of the patients were female. Only one case occurred earlier than 10 years after Fontan surgery. Twenty patients had no imaging or histological evidence of liver cirrhosis and 78.3% had elevated α‐fetoprotein levels. Advanced stage was the most common at diagnosis. The most frequent treatments were transarterial chemoembolization ( n = 18) and surgery ( n = 12). One‐year survival was 50% and only four patients (6.2%) were under liver imaging surveillance. We also analyzed 17 patients with non‐biopsy‐proven HCC. Conclusions After Fontan surgery, HCC usually occurs at least 10 years later and can develop in the absence of cirrhosis. Biopsy is mandatory to confirm the diagnosis. Patients were diagnosed at a late stage and survival outcomes were poor, highlighting a need for liver surveillance.