Hepatic resection for hepatocellular carcinoma

Abstract

One hundred and eighteen patients underwent hepatic resection for hepatocellular carcinoma from 1979 to 1987. Ninety-eight of these patients had co-existing cirrhosis of the liver; 18 patients underwent lobectomy, 28 patients had segmentectomy, and 52 patients had subsegmentectomy. In the 21 non-cirrhotic patients, 11 patients underwent lobectomy, 5 patients had segmentectomy, and 5 patients had subsegmentectomy. The operative mortality rate of patients with cirrhosis was 11% and of patients without cirrhosis was 5%. There was no significant difference in hepatic function tests between survivors and nonsurvivors. Lobectomy of < 55% of the parenchymal hepatic resection rate was well tolerated in the patients with cirrhosis. One-year, 3-year, and 5-year survival rates of patients with hepatocellular carcinoma and co-existing cirrhosis were 57.9%, 36.8% and 20.0% following lobectomy, 82.8%, 82.8% and 57.6% following segmentectomy, and 72.0%, 46.2% and 24.0% following subsegmentectomy. The tumor recurrence rate appeared to be lower after segmentectomy than subsegmentectomy. Multiple gross lesions, tumors > 5 cm, and presence of gross vascular invasion were poor prognostic signs in terms of survival rates as well as recurrence rates. Of the 51 patients with tumor recurrence limited to the residual liver, 13 patients underwent repeat resection, and 23 patients were treated by transcatheter arterial chemoembolization. The survival rates of the patients undergoing repeat resection were significantly better than those of other groups.

Multivariate and Univariate Analysis of Prognostic Factors following Resection in HCC: The Birmingham Experience

“…The operative mortality rate among our cirrhotics was 16.7%, which suggests the increased risk cirrhosis poses to surgery. This is similar to many studies which have reported a mortality rate between 10 and 20% [20,21,22], though Fong et al [12] have reported their mortality at 5% in cirrhotics. Recent reports by Teh et al [23] have shown a perioperative mortality of 16% in cirrhotics, which is similar to the mortality in our series.…”

Long term prognosis after hepatectomy for hepatocellular carcinoma

“…Vascular invasion was found to be an important prognostic factor in numerous studies. 10,11,18,[21][22][23][24][25][26][27]32,35,36 In the current study, microscopic venous permeation was an independent prognostic factor for disease free survival. Portal vein involvement was a significant prognostic factor in univariate analysis but not in multivariate analysis.…”

“…The pTNM classification of HCC is valuable in the evaluation of long term prognosis in patients following hepatec- tomy for HCC. 7,10,11,27 It is a useful adjunct in determining prognosis and formulating a treatment plan.…”

Avaliação da ressecção hepática em pacientes cirróticos com carcinoma hepatocelular

“…A partir da metade da década de 90, estudos com maior representatividade científica foram publicados, servindo, até os dias de hoje, como elementos de referência para os conhecimentos e recomendações relacionados ao tratamento do CHC (9,10,12,17,19,21,22,34,35,41,43) . Houve inúmeros fatores que contribuíram para que os resultados da RH no tratamento do CHC apresentassem mortalidade pós-operatória e sobrevida tardia aceitáveis (39) .…”