Liver surgery is safe in compensated liver cirrhosis

Abstract

Background: Factors predicting overall recurrence are well-known in hepatocarcinoma (HCC), but which of them are associated with local relapse (LR) on the surgical hedge rather than to an intrahepatic distant recurrence (DR) are still not explored. While local recurrence may be a surgical failure, distant may be the expression of a more advanced disease, which may be not preventable by surgery. The aim of the study was to assess the risk factors for both type of recurrence. Material & Methods: This is an international multicentric retrospective study. From 2010 to 2017, all consecutive patients with a first diagnosis of HCC without macrovascular invasion has been evaluated. Patients were analysed for local and distant recurrence. Uni and multivariate Cox analysis were employed for risk factors evaluation.Results: 376 patients were enrolled. 152 patients had recurrence, of whom 62 had LR while 90 DR. Patients with LR were less likely to be HCV positive (p:0.012), with an increased rate of satellitosis (p:0.015) and positive resection margin (p<0.001) when compared to all the others; however the extension of surgery (anatomic vs not) was not different. DR had an increased rate of major resections (p:0.020), satellitosis (p<0.001) and microvascular invasion (p:0.002). Nevertheless, local and distant recurrent patients were comparable between each other. Positive surgical margin (HR 2.1; 95%CI:1.5-5.1; p:0.012) -but not non-anatomical resection-was the only independent risk factor for LR. MVI (HR 2.2; 95%CI:1.1-4.3; p:0.023) was the only predictive factor for DR. Conclusion: Microvascular invasion predicted intra-hepatic distant recurrence and not local relapse after surgery, configuring a probable hallmark of advanced disease, and questioning the possibility to control the disease only by local curative therapies. LR seemed to be mostly the expression of a surgical failure.