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Review
. 2023 Jun;54(2):408-419.
doi: 10.1007/s12029-022-00830-2. Epub 2022 May 2.

Screening, Surveillance, and Management of Hepatocellular Carcinoma During the COVID-19 Pandemic: a Narrative Review

Sami Akbulut  1   2 , Ibrahim Umar Garzali  3   4 , Abdirahman Sakulen Hargura  3   5 , Ali Aloun  3 , Sezai Yilmaz  3
Affiliations
Review

Screening, Surveillance, and Management of Hepatocellular Carcinoma During the COVID-19 Pandemic: a Narrative Review

Sami Akbulut et al. J Gastrointest Cancer. 2023 Jun.

Abstract

Purpose: The COVID-19 pandemic has been a burden to the global community as a whole but the healthcare community had bore the brunt of it. The pandemic resulted in policy changes that interfered with effective healthcare delivery. The healthcare community attempted to cope with the pandemic by triaging and prioritizing emergency conditions especially COVID related, ahead of elective conditions like cancer care. There was also fear that patients with cancer were at an increased risk of sever COVID-19 with increased mortality. Hepatocellular carcinoma (HCC) was also affected by these policies.

Methods: We reviewed the modified measures adopted in screening, surveillance, and management of HCC during the pandemic using PubMed, Medline, Index Medicus, EMBASE, SCOPUS, and Google Scholar databases.

Result: The main modification in surveillance and screening for HCC during the pandemic includes limiting the surveillance to those with very high risk of HCC. The interval between surveillan was also delayed by few months in some cases. The adoption of teleconferencing for multidisciplinary team meetings and patient consultation is one of the highlights of this pandemic all in an effort to reduce contact and spread of the virus. The treatment of early-stage HCC was also modified as needed. The role of ablative therapy in the management of early HCC was very prominent during the pandemic as the surgical therapy was significantly affected by the lacks of ventilators and intensive care unit space resulting from the pandemic. Transplantation, especially living donor liver transplantation, was suspended in few centers because of the risk of infection to the living donors.

Conclusion: As we gradually recover from the pandemic, we should prepare for the fallout from the pandemic as we may encounter increased presentation of those patients deferred from screening during the pandemic.

Keywords: COVID-19 pandemic; Hepatocellular carcinoma, Liver resection; Liver transplantation; Screening, Surveillance.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Surveillance and diagnostic algorithm proposed by AASLD for patients at risk for HCC [17]
Fig. 2
Fig. 2
Diagnostic algorithm of EASL guideline for nodule (mass) by detected US in patients at risk of HCC [43]
Fig. 3
Fig. 3
Diagnostic algorithm of APASL guideline for nodule (mass) by detected US in patients at risk of HCC [44]
Fig. 4
Fig. 4
Modified Barcelona Clinic Liver Cancer (BCLC) staging system–based treatment algorithm during the COVID-19 pandemic (HCC: hepatocellular carcinoma; PS: performance status; SBRT: stereotactic body radiotherapy) [21, 45]
Fig. 5
Fig. 5
Proposed treatment pathway for hepatocellular carcinoma during the COVID-19 pandemic (LT: liver transplantation; SBRT: stereotactic body radiotherapy; PBT: proton beam therapy; RFA: radiofrequency ablation; MWA: microwave ablation; TARE: transarterial radioembolization; TACE: transarterial chemoembolization. TAE: transarterial embolization) [46]
See this image and copyright information in PMC

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