Hepatic resection for hepatocellular carcinoma exceeding Milan criteria |
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| Authors: | Spiros G. Delis Andreas Bakoyiannis Nikos Tassopoulos Kostas Athanassiou Dimitrios Kelekis Juan Madariaga Christos Dervenis |
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| Affiliation: | 1. Liver Surgical Unit, 1st Surgical Department, “Kostantopouleio-Agia Olga” Hospital, Athens, Greece;2. First Department of Medicine, Western Attica Gen. Hospital, Athens, Greece;3. 2nd Department of Radiology, Athens University Medical School, Athens, Greece;4. Division of Liver and GI Transplantation, University of Miami Miller School of Medicine, Miami, FL 33136, USA;1. Brighton and Sussex Medical School, Medical Research Building, University of Sussex, Brighton, United Kingdom;2. Royal Sussex County Hospital, Eastern Road, Brighton, United Kingdom;1. Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan;2. Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois;3. Division of Cardiology, Sensoji Hospital, Tokyo, Japan;4. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan;5. Department of Cardiology, Tokyo Women’s Medical University, Japan;6. Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan;1. Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women''s Hospital & Harvard Medical School, Boston, MA;2. Department of Epidemiology, Harvard School of Public Health, Boston, MA;1. Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan;2. Department of Molecular Genetics, Institute of DNA Medicine, The Jikei University School of Medicine, Tokyo, Japan;3. Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan;4. Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan |
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| Abstract: | BackgroundMany hepatocellular carcinomas (HCCs) are discovered at an advanced stage. The efficacy of transplantation for such tumors is doubtable. The aim of this retrospective study was to determine liver resection efficacy in patients with large HCC regarding long term and disease- free survival.MethodsBetween 2002 and 2008, sixty six patients with large HCC (>5 cm) underwent hepatectomy. Fifty nine patients had background cirrhosis due to hepatitis B, C or other reason and preserved liver function (Child A). Liver function was assessed by both Child's–Pugh grading and MELD score. Conventional approach of liver resection was performed in most cases.ResultsThe 5-year overall survival was 32% with a median follow up of 33 months. The three year disease-free survival was 33% in our cohort. On multivariate analysis, only tumor size and grade remained independent predictors of adverse long term outcome. Multivariate analysis identified size of the primary tumour and degree of differentiation as risk factors for recurrence. Median blood loss was 540 ml and median transfusion requirements were two units of pack red blood cells. Morbidity included pleural effusion (n = 18), biliary fistula (n = 4), peri-hepatic abscess (n = 4), hyperbilirubinemia (n = 3), pneumonia (n = 5) and wound infection (n = 6). No peri-operative mortality was reported in our study.ConclusionPartial hepatectomy is safe in selective patients with large HCC. Surgical resection if feasible is suggested in patients with large HCC because it prolongs both overall and disease-free survival with low morbidity. |
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