Abstract
Aim
Hepatic resections for hepatocellular carcinoma (HCC) in cirrhotic liver are characterized by early recurrence and poor survival. In this study, we analyzed several factors affecting both survival and recurrence after hepatic resection.
Patients and methods
From October 1995 to April 2007, 550 patients underwent hepatic resections, of which, 175 patients had HCC in cirrhotic liver in Gastroenterology Surgical Center, Mansoura University, Egypt. There were 131 males (74.9%) and 44 females (25.1%) with a mean age of 54.8 ± 9.2 years (ranges from 26 to 75 years).
Results
Most of our patients were in Child's Pugh class A (86.9%). Major hepatic resection was done for 65 patients (37.1%), segmentectomy was done for 62 patients (35.4%), and localized resection was done for 48 patients (27.4%). Hospital mortality occurred in 16 (9.1%) patients, while hospital morbidity occurred in 40% of patients. The 1, 3, and 5 years survival were 68.6%, 29.6%, and 10.7%, respectively. The prognostic factors affecting recurrence were multifactorial, and the univariate analysis showed that multifocality of the tumor (p = 0.006), capsule (p = 0.001), staging (p = 0.001), blood transfusion (p = 0.02), infiltration of the cut margin (p = 0.001), vascular invasion (p = 0.006), and lymph nodes infiltration (p = 0.014) affect the recurrence rate, while with multivariate analysis, only cut margin was significantly affecting the recurrence (p = 0.026). Also, factors that significantly predicted survival were preoperative serum albumin (p = 0.005), tumor differentiation (p = 0.008), staging (p = 0.001), tumor's capsule (p = 0.001), cut margin (p = 0.031), vascular invasion (p = 0.049), and operative blood transfusion (p = 0.001). However, tumor differentiation (p = 0.048) was the only independent factor on multivariate analysis affecting long-term survival.
Conclusion
In our experience, the prognostic factors after resection for recurrence and survival are different and multifactorial. However, resection of HCC in cirrhotic liver with preserved liver function is the treatment of choice in the present time and can be done with favorable results.
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References
Parkin DM, Bray F, Ferlay J, Pisani P (2001) Estimating the world cancer burden Globocan 2000. Int J Cancer 94:153–156
Bosch FX, Ribes J, Díaz M et al (2004) Primary liver cancer: worldwide incidence and trends. Gastroenterology 127:S5–S16
Sherman M (2005) Hepatocellular carcinoma: Epidemiology, risk factors, and screening. Semin Liver Dis 24:143–154
Siegel AB, McBride RB, El-Serag HB et al (2008) Racial disparities in utilization of liver transplantation for hepatocellular carcinoma in the United States, 1998–2002. Am J Gastroenterol 103:120–127
Chang C, Chau G, Lui W, Tsay S, King K, Wu C (2004) Long-term results of hepatic resection for hepatocellular carcinoma originating from the noncirrhotic liver. Arch Surg 139:320–325
Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917
Hemming AW, Cattral MS, Reed AI, Van der Werf WJ, Greig PD, Howard RJ (2001) Liver transplantation for hepatocellular carcinoma. Ann Surg 233:652–659
Abdel Wahab M, Sultan A, El-Ghawalby N, Fathy O et al (2004) Hepatic resection in cirrhotic liver for treatment of hepatocellular carcinoma in Egyptian patients: experience with 140 cases in a single center. Hepato-Gastroenterol 51:559–563
Yeh CN, Chen MF, Lee WC, Jeng LB (2002) Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis univariate and multivariate analysis. J Surg Oncol 81:195–202
Nagasue N, Uchida M, Makino Y et al (1993) Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology 105:488–494
Song T, Edmund Ip W, Fong Y (2004) Hepatocellular carcinoma: current surgical management. Gastroenterology 127:S248–S260
Ibrahim S, Roychowdhury A, Khoon Hean T (2007) Risk factors for intrahepatic recurrence after hepatectomy for hepatocellular carcinoma. Am J Surg 194:17–22
Kaibori M, Saito T, Matsui Y, Uchida Y, Ishizaki M, Kamiyaa Y (2007) A review of the prognostic factors in patients with recurrence after liver resection for hepatocellular carcinoma. Am J Surg 193:431–437
Taura K, Ikai I, Hatamo E, Yasuchika K, Nakajima A et al (2007) Influence of coexisting cirrhosis on outcomes after hepatic resection for hepatocellular carcinoma fulfilling the Milan criteria: an analysis of 293 patients. Surgery 142:685–694
Terminology Committee of the International Hepato-Pancreato-Biliary Association (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339
Adachi E, Maeda T, Matsumata T et al (1995) Risk factors for intrahepatic recurrence inhuman small hepatocellular carcinoma. Gastroenterology 108:768–775
Kumada T, Nakano S, Takeda I et al (1997) Patterns of recurrence after initial treatment in patients with small hepatocellular carcinoma. Hepatology 25:87–92
Nadig DE, Wade TP, Fairchild RB, Virgo KS, Johnson FE (1997) Major hepatic resection: indications and results in a national hospital system from 1988 to 1992. Arch Surg 132:115–119
Sun HC, Tang ZY (2003) Preventive treatments for recurrence after curative resection of hepatocellular carcinoma—a literature review of randomized control trials. World J Gastroenterol 9:635–640
Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, Sugawara Y, Minagawa M, Takayama T, Kawasaki S, Makuuchi M (2003) Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol 38:200–207
Poon RT, Fan ST, Ng IO, Lo CM, Liu CL, Wong J (2000) Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer 89:500–507
Ercolani G, Grazi GL, Ravaioli M, Del Gaudio M, Gardini A, Cescon M, Varotti G, Cetta F, Cavallari A (2003) Liver resection for hepatocellular carcinoma on cirrhosis univariate and multivariate analysis of risk factors for intrahepatic recurrence. Ann Surg 237:536–543
Poon RT, Fan ST, Lo CM, Liu CL, Wong J (2002) Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function implications for a strategy of salvage transplantation. Ann Surg 235:373–382
Shirabe K, Kanematsu T, Matsumata T, Adachi E, Akazawa K, Sugimachi K (1991) Factors linked to early recurrence of small hepatocellular carcinoma after hepatectomy:univariate and multivariate analyses. Hepatology 14:802–805
Sim GH, Lucien L, Ooi PJ (2003) Results of resections for hepatocellular carcinoma in a new hepatobiliary unit. ANZ J Surg 73:8–13
Jeng K, Sheen I, Tsai Y (2004) Does the presence of circulating hepatocellular carcinoma cells indicate a risk of recurrence after resection? Am J Gastroenterol 99:1503–1509
Portolani N, Coniglio A, Ghidoni S, Giovanelli M, Benetti A, Tiberio G, Giulini S (2006) Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and theraputic implications. Ann Surg 243:229–235
Yamamoto J, Kosuge T, Takayama T et al (1994) Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 115:303–309
Matsumata T, Ikeda Y, Hayashi H et al (1993) The association between transfusion and cancer free survival after curative resection for hepatocellular carcinoma. Cancer 72:1866–1871
Makino Y, Yamanoi A, Kimoto T, El-Assal ON, Kohno H, Nagasue N (2000) The influence of perioperative blood transfusion on intrahepatic recurrence after curative resection of hepatocellular carcinoma. Am J Gastroenterol 95:1294–1300
Okuno K, Ozaki M, Shigeoka H et al (1994) Effect of packed red cell and whole blood transfusion on liver-associated immune function. Am J Surg 168:340–344
Yamamoto M, Takasaki K, Ohtsubo T, Katsuragawa H, Fukuda C, Katagiri S (2001) Effectiveness of systematized hepatectomy with Glisson's pedicle transection at the hepatic hilus for small nodular hepatocellular carcinoma: retrospective analysis. Surgery 130(3):443–448
Regimbeau JM, Kianmanesh R, Farges O, Dondero F, Sauvanet A, Belghiti J (2002) Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma. Surgery 131(3):311–317
The Liver Cancer Study Group of Japan (1990) Primary liver cancer in Japan. Ann Surg 211:277
Ko S, Kanehiro H, Hisanaga M, Nagao M, Ikeda N, Nakajima Y (2002) Liver fibrosis increases the risk of intrahepatic recurrence after hepatectomy for hepatocellularcarcinoma. Br J Surg 89(1):57–62
Jonas S, Bechstein W, Steinmuller T, Hermann M, Radke C, Berg T (2001) Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology 33:1080–1086
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Mohamed Abdel-Wahab made substantial contributions to study conception and design and critical revision of the manuscript. Mohamed Shobray and Emad Hamdy are responsible for the acquisition of data. Ehab Elhanafy is responsible for the analysis and interpretation of data. Drafting of manuscript was done by Tarek Salah El-Husseiny.
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Abdel-Wahab, M., El-Husseiny, T.S., El Hanafy, E. et al. Prognostic factors affecting survival and recurrence after hepatic resection for hepatocellular carcinoma in cirrhotic liver. Langenbecks Arch Surg 395, 625–632 (2010). https://doi.org/10.1007/s00423-010-0643-0
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DOI: https://doi.org/10.1007/s00423-010-0643-0