Hepatic resection for large hepatocellular carcinoma in the era of UCSF criteria |
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Authors: | Spiros G Delis Andreas Bakoyiannis Nikos Tassopoulos Kostas Athanassiou Aristotelis Kechagias Dimitrios Kelekis Juan Madariaga Christos Dervenis |
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Institution: | 1.Liver Surgical Unit, First Surgical Department, Kostantopouleio-Agia Olga Hospital, Athens, Greece;2.Division of Liver and Gastrointestinal Transplantation, University of Miami Miller School of Medicine, Miami, FL, USA;3.First Department of Medicine, Western Attica General Hospital, Athens, Greece;4.Second Department of Radiology, Athens University Medical School, Athens, Greece |
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Abstract: | Background:Treating patients with hepatocellular carcinoma (HCC) remains a challenge, especially when the disease presents at an advanced stage. The aim of this retrospective study was to determine the efficacy of liver resection in patients who fulfil or exceed University of California San Francisco (UCSF) criteria by assessing longterm outcome.Methods:Between 2002 and 2008, 59 patients with large HCC (>5 cm) underwent hepatectomy. Thirty-two of these patients fulfilled UCSF criteria for transplantation (group A) and 27 did not (group B). Disease-free survival and overall survival rates were compared between the two groups after resection and were critically evaluated with regard to patient eligibility for transplant.Results:In all patients major or extended hepatectomies were performed. There was no perioperative mortality. Morbidity consisted of biliary fistula, abscess, pleural effusion and pneumonia and was significantly higher in patient group B. Disease-free survival rates at 1, 3 and 5 years were 66%, 37% and 34% in group A and 56%, 29% and 26% in group B, respectively (P < 0.01). Survival rates at 1, 3 and 5 years were 73%, 39% and 35% in group A and 64%, 35% and 29% in group B, respectively (P= 0.04). The recurrence rate was higher in group B (P= 0.002).Conclusions:Surgical resection, if feasible, is suggested in patients with large HCC and can be performed with acceptable overall and disease-free survival and morbidity rates. In patients eligible for transplantation, resection may also have a place in the management strategy when waiting list time is prolonged for reasons of organ shortage or when the candidate has low priority as a result of a low MELD (model for end-stage liver disease) score. |
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Keywords: | large HCC hepatocellular carcinoma MELD score liver resection hepatectomy |
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