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Öğe A Case Report of Excessive Inflammation After TACE That Mimicked Tumor Invasion of Adjacent Tissues(Sage Publications Inc, 2023) Ince, Volkan; Garzali, Ibrahim Umar; Usta, Sertac; Kutlu, Ramazan; Yilmaz, Sezai[Abstract Not Available]Öğe Clinical presentation, management, screening and surveillance for colorectal cancer during the COVID-19 pandemic(Baishideng Publishing Group Inc, 2022) Akbulut, Sami; Hargura, Abdirahman Sakulen; Garzali, Ibrahim Umar; Aloun, Ali; Colak, CemilManagement of colorectal cancer (CRC) was severely affected by the changes implemented during the pandemic, and this resulted in delayed elective presentation, increased emergency presentation, reduced screening and delayed definitive therapy. This review was conducted to analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic on management of CRC and to identify the changes made in order to adapt to the pandemic. We performed a literature search in PubMed, Medline, Index Medicus, EMBASE, SCOPUS, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Google Scholar using the following keywords in various combinations: Colorectal cancer, elective surgery, emergency surgery, stage upgrading, screening, surveillance and the COVID-19 pandemic. Only studies published in English were included. To curtail the spread of COVID-19 infection, there were modifications made in the management of CRC. Screening was limited to high risk individuals, and the screening tests of choice during the pandemic were fecal occult blood test, fecal immunochemical test and stool DNA testing. The use of capsule colonoscopy and open access colonoscopy was also encouraged. Blood-based tests like serum methylated septin 9 were also encouraged for screening of CRC during the pandemic. The presentation of CRC was also affected by the pandemic with more patients presenting with emergencies like obstruction and perforation. Stage migration was also observed during the pandemic with more patients presenting with more advanced tumors. The operative therapy of CRC was altered by the pandemic as more emergencies surgeries were done, which may require exteriorization by stoma. This was to reduce the morbidity associated with anastomosis and encourage early discharge from the hospital. There was also an initial reduction in laparoscopic surgical procedures due to the fear of aerosols and COVID-19 infection. As we gradually come out of the pandemic, we should remember the lessons learned and continue to apply them even after the pandemic passes.Öğe Effect of COVID-19 Pandemic on Patients Who Have Undergone Liver Transplantation Because of Hepatocellular Carcinoma(Elsevier Science Inc, 2023) Akbulut, Sami; Bagci, Nazlican; Akyuz, Musap; Garzali, Ibrahim Umar; Saritas, Hasan; Tamer, Murat; Ince, VolkanBackground and Aim. Many clinical studies have shown that the COVID-19 case fatality rate is higher in older patients, those with comorbidities, those with immunosuppressive conditions, and those who stay in the intensive care unit. This study aims to evaluate the clinical outcomes of 66 liver transplant (LT) patients with primary liver cancer who were exposed to COVID-19 infection.Methods. Demographic and clinical data of 66 patients with primary liver cancer (hepatocellu-lar carcinoma = 64, hepatoblastoma = 1, cholangiocarcinoma = 1) who underwent LT in our institute and were exposed to COVID-19 infection between March 2020 and November 2021 were analyzed in this cross-sectional study. The following data of the patients were recorded: age, sex, body mass index (kg/m2), blood group, underlying primary liver disease, smoking, tumor characteristics, post-transplant immunosuppressive agents, COVID-19 symptoms, hospi-talization, intensive care unit stay, intubation, and other clinical features. Results. There were 55 (83.3%) male and 11 (16.7%) female patients, with a median age of 58 years. Sixty-four patients were exposed to COVID-19 only once, whereas the remaining 2 patients were exposed 2 and 4 times, respectively. After exposure to COVID-19, it was deter-mined that 37 patients used antiviral drugs, 25 were hospitalized, 9 were followed in the inten-sive care unit, and 3 were intubated. One intubated patient was under hospital follow-up because of biliary complications before exposure to COVID-19, and this patient died from sepsis. Conclusion. The low mortality rate of LT patients with primary liver cancer exposed to COVID-19 infection can be attributed to background immunosuppression that prevents cytokine storm. However, it is appropriate to support this study with multicenter studies to make strong comments on this issue.Öğe Effect of COVID-19 Pandemic on Patients Who Have Undergone Liver Transplantation: Retrospective Cohort Study(Mdpi, 2023) Akbulut, Sami; Yagin, Fatma Hilal; Sahin, Tevfik Tolga; Garzali, Ibrahim Umar; Tuncer, Adem; Akyuz, Musap; Bagci, NazlicanBackground: In liver transplant (LT) recipients, immunosuppressive therapy may potentially increase the risk of severe COVID-19 and may increase the mortality in patients. However, studies have shown conflicting results, with various studies reporting poor outcomes while the others show no difference between the LT recipients and healthy population. The aim of this study is to determine the impact of the COVID-19 pandemic on survival of LT recipients. Methods: This is a retrospective cohort study analyzing the data from 387 LT recipients diagnosed with COVID-19. LT recipients were divided into two groups: survival (n = 359) and non-survival (n = 28) groups. A logistic regression model was used to determine the independent risk factors for mortality. Machine learning models were used to analyze the contribution of independent variables to the mortality in LT recipients. Results: The COVID-19-related mortality rate in LT recipients was 7.2%. Multivariate analysis showed that everolimus use (p = 0.012; OR = 6.2), need for intubation (p = 0.001; OR = 38.4) and discontinuation of immunosuppressive therapy (p = 0.047; OR = 7.3) were independent risk factors for mortality. Furthermore, COVID-19 vaccination reduced the risk of mortality by 100 fold and was the single independent factor determining the survival of the LT recipients. Conclusion: The effect of COVID-19 infection on LT recipients is slightly different from the effect of the disease on the general population. The COVID-19-related mortality is lower than the general population and vaccination for COVID-19 significantly reduces the risk of mortality.Öğe Effect of Pre-Transplant Covid-19 Exposure on Post-Liver Transplant Clinical Outcomes(Elsevier Science Inc, 2023) Akbulut, Sami; Barut, Bora; Garzali, Ibrahim Umar; Sarici, Kemal Baris; Tamer, Murat; Unsal, Selver; Karabulut, ErtugrulBackground. COVID-19 has led to an unprecedented global health crisis. This situation caused an immediate reduction in solid organ transplantation activity. This study aimed to present the follow-up results of patients with chronic liver disease who underwent liver transplantation (LT) after a history of COVID-19 infection. Methods. Sociodemographic characteristics and clinicopathological data of 474 patients who underwent LT at Inonu University Liver Transplant Institute between March 11, 2020 and March 17, 2022 were prospectively recorded and analyzed retrospectively. Among these, the data of 35 patients with chronic liver disease who were found to be exposed to COVID-19 infection in the pre-LT period were analyzed for this study. Results. The median body mass index, Child score, and Model for end-stage liver disease/ Pediatric end-stage liver disease scores of the 35 patients were calculated as 25.1 kg/m2 (IQR: 7.4), 9 points (IQR: 4), and 16 points (IQR: 10), respectively. Graft rejection occurred in 4 patients at a median of 25 days post-transplant. Five patients underwent retransplantation at a median of 25 days post-transplant. The most common cause of retransplantation is early hepatic artery thrombosis. There were 5 deaths during postoperative follow-up. Mortality developed in 5 (14.3%) patients exposed to COVID-19 infection in the pretransplant period, whereas mortality occurred in 56 (12.8%) patients not exposed to COVID-19 infection. There was no statistically significant difference in mortality between the groups (P = .79). Conclusions. The results of this study showed that exposure to COVID-19 before LT does not affect post-transplant patients and graft survival.Öğe An Elbow Patch Reconstruction Technique for Narrowed Remnant Portal Veins during Right Lobe Living Donor Hepatectomy: A Rescue Surgery(Mdpi, 2024) Usta, Sertac; Akbulut, Sami; Sarici, Kemal Baris; Garzali, Ibrahim Umar; Ozdemir, Fatih; Gonultas, Fatih; Baskiran, AdilBackground: Treatment of established portal vein narrowing after living donor hepatectomy is challenging. We aimed to present a new approach termed the elbow patch reconstruction technique to correct the narrowed remnant portal vein just or late after right lobe living donor hepatectomy. Methods: Demographic and clinical data of 12 living liver donors with narrowed remnant portal veins and treated with the elbow patch reconstruction technique were prospectively collected and retrospectively evaluated. Anatomic variation of the portal vein was defined in accordance with the Nakamura classification; six of the living liver donors had type A, three had type B, and the remaining three had type C. In eight of the living liver donors with a narrowed remnant portal vein, diagnosis was detected by intraoperative Doppler ultrasonography and visual inspection by experienced transplant surgeons in the living donor hepatectomy procedure. In the remaining four living liver donors, diagnosis was performed postoperatively when elevation of liver enzymes was noticed during the routine liver function test and Doppler US. The diagnosis was confirmed by multidetector computed tomography. Results: Data from nine males and three females aged 18 to 54 years were analyzed. All of the living liver donors were followed up for a median of 1710 days (min-max: 1178-4447 days; IQR: 1516 days), and none of the living liver donors had any structural or functional complications in the portal vein. Conclusions: Narrowing remnant portal veins are rare, but they are a life-threatening complication in living liver donors, and this condition requires urgent management. Image guided interventions and narrowed segment resection with end-to-end anastomosis using a vascular graft carried a potential risk for thrombosis and restenosis. To avoid these complications, we shared a technique named elbow patch reconstruction technique. This technique can be very effective in relieving the narrowing of the remnant portal vein after right lobe living donor hepatectomy.Öğe Evaluation of Bone Mineral Metabolism After Liver Transplantation by Bone Mineral Densitometry and Biochemical Markers(Elsevier Science Inc, 2023) Sarici, Kemal Baris; Akbulut, Sami; Uremis, Muhammed Mehdi; Garzali, Ibrahim Umar; Kucukakcali, Zeynep; Koc, Cemalettin; Turkoz, YusufAim. This study aimed to evaluate the course of bone and mineral metabolism after liver trans-plantation (LT) in patients with chronic liver disease.Methods. One hundred four patients who had undergone LT and had a minimum of 6 months of follow-up after LT were included in this prospective cohort study. The following parameters were evaluated for each patient: preoperative and postoperative (postoperative day [POD]30, POD90, POD180) osteocalcin, bone-specific alkaline phosphatase (BALP), type 1 collagen, beta-C-terminal end telopeptide (b-CTx), vitamin D, parathyroid hormone (PTH), ALP, calcium, phosphate, sedimentation, and bone mineral densitometer scores (L2, L4, L total, and F total). The parameters were compared in terms of sex, presence of liver tumor (hepatocellular carci-noma [HCC; n = 19] vs non-HCC [n = 85]), and presence of autoimmune liver disease (autoim-mune liver disease [ALD; n = 8] vs non-ALD [n = 96]). Results. The median age of the patients (n = 81 men and n = 23 women) was 52 years (95% CI, 50-56). There was a significant change in the defined time intervals in parameters such as osteocalcin (P < .001), BALP (P < .001), b-CTx (P < .001), vitamin D (P < .001), PTH (P < .001), ALP (P = .001), calcium (P < .001), phosphate (P = .001), L2 (P = .038), L total (P = .026), and F total (P < .001) scores. There was a significant difference in POD90 ALP (P = .033), POD180 calcium (P = .011), POD180 phosphate (P = .011), preoperative sedimentation (P = .032), and POD180 F total (P = .013) scores between both sexes. There was a significant difference in POD180 osteocalcin (P = .023), POD180 b-CTx (P = .017), and preOP calcium (P = .003) among the HCC and non-HCC groups. Furthermore, we found significant differences in preoperative ALP (P = .008), preop-erative sedimentation (P = .019), POD90 (P = .037) and POD180 L2 (P = .005) scores, preoperative (P = .049) and POD180 L4 (P = .017), and POD180 L total (P = .010) and F total (P = .022) scores between the patients with and without ALD. Conclusion. This study shows that the bone and mineral metabolism of the LT recipients was negatively affected after LT. In addition, we showed that bone and mineral metabolism was more prominent in patients with HCC, and bone mineral density scores were higher in patients with ALD.Öğe Evaluation of the coexistence of pilonidal sinus disease and hirsutism in female patients: a retrospective cross-sectional study(Lippincott Williams & Wilkins, 2023) Akbulut, Sami; Caliskan, Alper; Yilmaz, Davut; Atay, Arif; Garzali, Ibrahim Umar; Yagmur, YusufBackground:This study aimed to investigate the coexistence of pilonidal sinus disease (PSD) and hirsutism in female patients. Materials and methods:The demographic and clinical data of 164 female patients who underwent surgery for PSD between January 2007 and May 2014 were evaluated for this retrospective cross-sectional study. Data collected for this study were age, BMI, the modified Ferriman and Gallwey scale (mFGS) for hirsutism, main symptoms, type of surgery, early postoperative complications (wound infection, wound dehiscence), recurrence, and follow-up. The independent variables are hirsutism (mFGS scores) and BMI. Dependent variables are early postoperative complications and recurrence. Results:The median age was 20 years (95% CI for median: 19-21 years). According to the BMI, 45.7, 50.6, and 3.7% of patients were considered normal, overweight, and obese, respectively. According to the mFGS, 11, 9.8, 52.4, and 26.8% of patients were considered to have none, mild, moderate, or severe hirsutism, respectively. Fourteen (8.5%) patients had developed recurrence. Recurrence developed in six patients with primary closure, five patients with Limberg flaps, two patients with Karydakis, and one with marsupialization. There was no statistical difference between recurrent and nonrecurrent patients in terms of BMI (P=0.054) and mFGS (P=0.921). On the other hand, BMI was statistically significantly higher in those who developed early postoperative complications than in those who did not (P<0.001). Conclusion:PSD is no longer a 'men's only disease'. BMI increases the risk of early postoperative complications, but this association was not found between BMI and recurrence. Prospective multicenter studies are needed on the relationship between PSD and hirsutism.Öğe Histopathological Features of Gallbladder Specimens Obtained From Liver Recipients(Elsevier Science Inc, 2023) Sarici, Kemal Baris; Akbulut, Sami; Karabulut, Ertugrul; Sahin, Tevfik Tolga; Kucukakcali, Zeynep; Garzali, Ibrahim Umar; Aloun, AliBackground. To evaluate the histopathological features of gallbladder specimens obtained from liver transplantation (LT) recipients and to find the correlation between these findings with the clinical features of patients. Methods. The 1985 patients who underwent LT in our institute between March 2002 and January 2021 and whose data regarding pathologic analysis of gallbladder could retrospectively be obtained were included in the study. The data of the patients including age, gender, the reason for LT (fulminant or nonfulminant), presence of ascites, macroscopic characteristics of gallblad-der (the length, diameter, and wall thickness), and microscopic findings were all obtained and analyzed in the present study. Results. A total of 1985 patients (men = 1300 and women = 685) with a median age of 39.4 years were included in this study. LT was performed in 249 patients because of fulminant liver failure, and abdominal ascites were detected in 933 patients during LT. There were statisti-cal differences in terms of age (P < .001), gallbladder length (P < .001). and width (P < .001) among the both gender, but there was no difference in terms of histopathologic characteristics and presence of gallstones. On the other hand, there were significant differences in terms of age (P < .001), gallbladder length (P < .001), width (P < .001), wall thickness (P = .021), presence of gallstones (P < .001), and histopathologic characteristics (P < .001) between the patients with fulminant and nonfulminant liver failure etiologies. Similar results were obtained when characteristics of patients with and without ascites were compared. Conclusions. This the first study analyzing the histopathological analysis of gallbladder specimens in LT recipients. Chronic liver disease, presence of ascites and gender are the factors affecting the macroscopic and microscopic features of the gallbladder.Öğe Liver Transplantation for Hepatocellular Carcinoma in Patients with Inherited Metabolic Liver Diseases: A Single-Center Analysis(Aves, 2023) Garzali, Ibrahim Umar; Hargura, Abdirahman Sakulen; Ince, Volkan; Varol, Fatma Ilknur; Carr, Brian I.; Yilmaz, SezaiBackground/Aims: Liver transplantation is an acceptable treatment for some selected hepatocellular carcinoma. We report our experi-ence of 6 patients with liver transplantation for hepatocellular carcinoma with background inherited metabolic disease. Materials and Methods: This is a single-center retrospective, descriptive study. Consecutive patients who underwent liver transplanta-tion for hepatocellular carcinoma with background inherited metabolic disease were included in the study. The record of the patients was accessed, and the following data were extracted: sociodemographic variables, type of metabolic disease, date of liver transplan-tation, tumor characteristics, laboratory parameters, Model for End-Stage Liver Disease score, immediate-and long-term outcome after transplantation, disease-free survival, and overall survival. Data were analyzed using Statistical Package for the Social Sciences version 25.0. Results: Six patients received liver transplantation for hepatocellular carcinoma with background inherited metabolic liver disease. The median age was 4.5 years. The median Model for End-Stage Liver Disease score was 29.30. The median maximum tumor diameter was 2.15 cm. Three patients had multiple tumor nodules. Half of the patients had microvascular invasion. Four of the patients had a mod-erately differentiated tumor. Progressive familial intrahepatic cholestasis type II is the commonest inherited metabolic disease seen in 3 patients. Median follow-up is 46.1 months. Half of the patients are currently more than 5 years post liver transplantation with no features of recurrence. The estimated survival rates at 1, 3, and 5 years are 100%, 83.3%, and 83.3%, respectively. Conclusion: Liver transplant for these categories of patients is associated with good disease-free and overall survival, even in the pres-ence of some seemingly poor prognostic features.Öğe Measurement of Heavy Metal and Antioxidant-Oxidant Levels in Tissues Obtained From Three Different Localizations of Explant Hepatectomy of Patients With Hepatocellular Carcinoma(Elsevier Science Inc, 2023) Koc, Cemalettin; Akbulut, Sami; Sarici, Kemal Baris; Uremis, Muhammed Mehdi; Dogan, Ufuk Gunay; Kucukakcali, Zeynep; Garzali, Ibrahim UmarBackground. To reveal any difference in terms of heavy metal and antioxidant/oxidant levels of liver tissues obtained from 3 different locations of hepatectomy specimens of patients with Methods. Total hepatectomy materials of patients who underwent liver transplantation for HCC were objects of this study. Three liver tissue samples were obtained from each material, one from HCC tissue, one adjacent from the border of HCC, and one at least 3 cm distant from HCC, each 10 & POUND; 10 mm in diameter. Samples are preserved at -70 & DEG;C. Levels of heavy metals (As, Cd, Cu, Mn, Pb, Se, and Zn) and oxidant-antioxidant parameters (catalase, glutathione perand disulphid) are measured. Results. This study included 22 patients (18 men, 4 women with an age range of 3 to 66 years. There were significant differences in terms of Cd, Pb, Zn, GSHPx, SOD, nitric oxide, and native thiol levels between liver tissues derived from 3 different locations. Cd, Pb, and Zn levels were significantly different in tumor tissues, whereas GSHPx and SOD levels were significantly different in tumor and neighboring tissues. Nitric oxide levels were relatively different in tumor tissues compared with tumor-neighboring tissues. Native thiol levels differed significantly in tumor tissues compared with tissues distant from tumor. Conclusions. The aim of this study is unique in medical literature, which reveals that the amount of heavy metals and antioxidant/oxidant accumulation are variable in the same liver tissue in different locations because of multiple and yet unknown factors.Öğe Microvascular Invasion in Hepatocellular Carcinoma: Some Puzzling Facets(Aves, 2024) Garzali, Ibrahim Umar; Carr, Brian I.; Ince, Volkan; Isik, Burak; Akatli, Ayse Nur; Yilmaz, SezaiBackground/Aims: Hepatocellular carcinoma is the main type of primary liver cancer. Macroscopic vascular invasion is usually identified during imaging, whereas microvascular invasion is usually determined by histopathological evaluation. We aim to identify the association between microvascular invasion and other markers of tumor aggressiveness and to identify the role of microvascular invasion in the prognosis of patients who were treated by liver transplantation for hepatocellular carcinoma. Materials and Methods: This is a single -center retrospective analysis of prospectively collected data. Patients who received liver transplantation for hepatocellular carcinoma were included in the study. Data were collected regarding sociodemographic variables, criteria of selection for liver transplantation, pretransplant alpha-fetoprotein, presence or absence of microvascular invasion, presence or absence of recurrence, overall survival, and disease -free survival. Data were analyzed using Statistical Package for the Social Sciences. Results: Sociodemographic laboratory values and radiologic tumor characteristics were found to be similar infconclu patients with or without microvascular invasion. Our study revealed that microvascular invasion is associated with increased recurrence, decreased diseasedfree survival, and decreased overall survival, only for patients with hepatocellular carcinoma beyond Milan criteria at the time of liver transplantation. Conclusion: For patients beyond Milan criteria, but not within Milan criteria, microvascular invasion plays a significant role in predicting recurrence and shorter survival after liver transplantation.Öğe Outcome of split liver transplantation vs living donor liver transplantation: A systematic review and meta-analysis(Baishideng Publishing Group Inc, 2023) Garzali, Ibrahim Umar; Akbulut, Sami; Aloun, Ali; Naffa, Motaz; Aksoy, FuatBACKGROUNDThe outcomes of liver transplantation (LT) from different grafts have been studied individually and in combination, but the reports were conflicting with some researchers finding no difference in both short-term and long-term outcomes between the deceased donor split LT (DD-SLT) and living donor LT (LDLT).AIMTo compare the outcomes of DD-SLT and LDLT we performed this systematic review and meta-analysis.METHODSThis systematic review was performed in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The following databases were searched for articles comparing outcomes of DD-SLT and LDLT: PubMed; Google Scholar; Embase; Cochrane Central Register of Controlled Trials; the Cochrane Database of Systematic Reviews; and Reference Citation Analysis (https://www.referencecitationanalysis.com/). The search terms used were: liver transplantation; liver transplant; split liver transplant; living donor liver transplant; partial liver transplant; partial liver graft; ex vivo splitting; and in vivo splitting.RESULTSTen studies were included for the data synthesis and meta-analysis. There were a total of 4836 patients. The overall survival rate at 1 year, 3 years and 5 years was superior in patients that received LDLT compared to DD-SLT. At 1 year, the hazard ratios was 1.44 (95% confidence interval: 1.16-1.78; P = 0.001). The graft survival rate at 3 years and 5 years was superior in the LDLT group (3 year hazard ratio: 1.28; 95% confidence interval: 1.01-1.63; P = 0.04).CONCLUSIONThis meta-analysis showed that LDLT has better graft survival and overall survival when compared to DD-SLT.Öğe Prognostic role of platelet lymphocyte ratio (PLR) among patients with hepatocellular carcinoma undergoing liver transplantation(2023) Garzali, Ibrahim Umar; Hargura, Abdirahman Sakulen; İnce, Volkan; Usta, Sertaç; Aloun, Ali; Carr, Brian I.; Yılmaz, SezaiAim: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, but it is so aggressive that is the third most common cause of cancer related death. We aim to study the role of PLR in prognosis of HCC and to see if it can be a predictor of overall survival and disease-free survival among HCC patients that received liver transplantation in our center. Materials and Methods: This is a single center retrospective analysis of prospectively collected data. The study was carried out in liver transplant institute of Inonu University, Malatya, Turkey. Consecutive patients that received liver transplantation for HCC and survive for at least 90 days post transplantation were included in the study. Data was collected regarding age, gender, presence or absence of cirrhosis, cause of cirrhosis, number of nodules, maximum size of the tumor, preoperative PLR, pre-transplant GGT, type of transplant, presence or absence of microvascular invasion, overall survival and disease-free survival. The study was censored on June 2022. Data was analyzed using SPSS version 25. Results: Platelet lymphocyte ratio was found to be significantly associated with some poor prognostic factors of HCC in our patients. We found that PLR is significantly associated with maximum tumor diameter (MTD) and total tumor diameter (TTD) with p= <0.0001 and 0.0016 respectively. Univariate analysis revealed that PLR is a predictor of worse DFS or OS but when subjected to multivariate analysis, we found that PLR is not an independent predictor of OS and DFS. Conclusion: Platelet lymphocyte ratio is associated with poor prognostics feature of hepatocellular carcinoma.Öğe Screening, Surveillance, and Management of Hepatocellular Carcinoma During the COVID-19 Pandemic: a Narrative Review(Springer, 2023) Akbulut, Sami; Garzali, Ibrahim Umar; Hargura, Abdirahman Sakulen; Aloun, Ali; Yilmaz, SezaiPurpose 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.
