Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma

doi:10.1016/S0002-9610(99)80106-8

The American Journal of Surgery

Volume 169, Issue 1, January 1995, Pages 28-35

https://doi.org/10.1016/S0002-9610(99)80106-8 Get rights and content

Background

Experience with hepatocellular carcinoma (HCC) is limited in the West and factors affecting outcome after resection are not clearly defined.

Methods

Between 1970 and 1992, 106 patients (including 74 Caucasians, 31 Orientals, and 1 black) underwent hepatic resection for HCC at Memorial Sloan-Kettering Cancer Center. Clinical and histopathologic factors of outcome were analyzed.

Results

Cirrhosis was present in 33% and 95% were Child-Pugh A. Operative mortality was 6%, 14% in cirrhotics versus 1% in noncirrhotics (P = 0.013). Orientals had a higher prevalence of cirrhosis (68% versus 19%) (P <0.0001) and smaller tumors (mean 8.7 cm versus 11.0 cm) (P = 0.028) compared to Caucasians. Overall survival was 41% and 32% at 5 and 10 years, respectively. By univariate analysis, survival was greater in association with the following: absence of vascular invasion (69% versus 28%, P = 0.002); absence of symptoms (66% versus 38%, P = 0.014); solitary tumor (53% versus 28%, P = 0.014); negative margins (46% versus 21%, P = 0.022); small tumor (≤5 cm) (75% versus 36%, P = 0.027); and presence of tumor capsule (69% versus 35%, P = 0.047). Ethnic origin, cirrhosis, necrosis and grade did not affect survival. By multivariate analysis, only vascular invasion predicted outcome (P = 0.0025, risk ratio 2.9).

Conclusions

One third of patients resected for HCC can be expected to survive long-term. Except for a higher incidence of cirrhosis in Orientals, no major histopathologic or prognostic differences were noted between Orientals and Caucasians undergoing resection. Early cirrhosis (Child-Pugh A) did not adversely affect survival. Vascular invasion predicted long-term outcome.

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La supervivencia global a 1, 3 y 5 años fue del 66,7, del 33,3 y del 22,2%, respectivamente, en los pacientes con IMV, y del 90,7, del 72,4 y del 52,2% en el grupo sin IMV (p = 0,009).
La hepatectomía asociada a trombectomía parece estar justificada en un grupo seleccionado de pacientes con CHC e IMV, pudiendo aportar un beneficio de supervivencia con una aceptable tasa de morbilidad.
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Retrospective cohort study of patients who underwent liver resection for HCC in the period 2007-2015 (n = 120). Of all the patients, 108 did not have MVI, while 12 presented with MVI: 1 patient in the common portal vein (Vp4), 8 patients in first-order portal branches (Vp3), 1 patient in a sectorial branch (Vp2), 1 patient in a segmental branch (Vp1); another patient presented with tumor thrombus in a main hepatic venous branch in the confluence with the vena cava (Vv2).
Patients with MVI needed major hepatic resection more frequently than patients without MVI (83.3% vs 25.9%, P < .0001), with no differences in postoperative mortality or severe morbidity. Patients with MVI required a longer operative time and developed more frequently postoperative ascites (33.3% vs 9.3%, P = .034).
Global survival at 1, 3 and 5 years was 66.7%, 33.3% and 22.2% in patients with IMV, and 90.7%, 72.4% and 52.2% in patients without IMV (P = .009), respectively.
Hepatectomy associated with thrombectomy might be justified in a selected group of patients with HCC and MVI, offering a potential benefit in survival with acceptable morbidity.
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One hundred three patients who underwent pulmonary metastasectomy for HCC between January 2005 and December 2016 were retrospectively evaluated. Patient demographic data and characteristics of the primary tumors and pulmonary metastasis were investigated to identify factors significantly correlated with prognosis.
Of 103 patients, 75 (72.8%) had 1 site pulmonary metastasis, 22 (21.4%) had 2, and 6 (5.8%) had 3 or more. Liver recurrence at the time of pulmonary metastasectomy was noted in 34 patients. The estimated 5-year overall survival rate was 38.5% after pulmonary metastasectomy. Univariate prognostic analysis showed that liver recurrence at the time of pulmonary metastasectomy, extent of resection, laterality of pulmonary metastasis, tumor location, number of metastatic sites, and metastatic tumor size were significantly associated with favorable overall survival after pulmonary metastasectomy. Multivariate analysis revealed that liver recurrence at the time of pulmonary metastasectomy and the number of metastatic sites were independent prognostic factors. Subgroup analysis with a combination of these 2 independent prognostic factors revealed 5-year overall survival rates for patients with 0, 1, and 2 risk factors of 58.5%, 23.8%, and 0.0%, respectively.
Pulmonary metastasectomy is a safe and effective treatment for well-selected patients with pulmonary metastasis of HCC. Liver recurrence at the time of pulmonary metastasectomy and the number of metastatic sites were identified as independent prognostic factors. The number of risk factors significantly influenced patient survival.
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To investigate the feasibility of using texture analysis in preoperative magnetic resonance imaging (MRI) to predict early recurrence (ER) in hepatocellular carcinoma (HCC) post-curative surgery.
Institutional review board was obtained. A retrospective review of all patients who underwent hepatectomy between 1 January 2007 and 31 December 2015 was performed. Inclusion criteria included preoperative MRI, tumour size ≥1 cm, new cases of HCC. Exclusion criteria included loss to follow-up, ruptured HCCs, movement artefacts, and previous hepatectomy or interval adjuvant therapy. Patients were divided into ER and late or no recurrence (LNR) groups. ER was defined as new foci of HCC within 730 days of curative surgery. Radiomics feature extraction was performed on T2, diffusion-weighted imaging (DWI), T1 arterial, and T1 portovenous acquisitions on MATLAB (Mathworks, Matick, MA, USA). The MaZda software was used to analyse 290 texture parameters and PRTools was used for feature selection.
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Citation Excerpt :
The haematogenous spread of malignant cells during surgical resection has been reported in pancreatic, colorectal and prostate cancer [34–36]. Furthermore, venous permeation and vascular penetration by malignant processes occur frequently in HCC, which may result in the pre-operative dissemination of these cells as well [37,38]. The increased manipulation and mobilisation of the tumour that occurs in OH may promote the spread of these malignant cells into the systemic and intrahepatic portal venous system [39–42].
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¹: Supported by the Enid Haupt Chair in Surgery.

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Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma

Background

Methods

Results

Conclusions

Gastroenterology.

Am J Surg.

Am J Surg.

Gastroenterology.

Am J Surg.

Am J Surg.

Am J Surg.

Cancer statistics, 1994

CA Cancer J Clin.

Primary hepatocellular cancers—Western experience

Primary carcinoma of the liver: improvement in sight?

World J Surg.

One hundred hepatic resections

Ann Surg.

Comparison of outcome between extended and non-extended liver resections for neoplasms

Surgery.

Clinical experience with 118 hepatic resections for hepatocellular carcinoma

Surgery.

Personal experience with 411 hepatic resections

Ann Surg.

National public health, its trend

Koseino-Shihyo.

Hepatic resection for hepatocellular carcinoma. Clinical features and long-Term prognosis

Ann Surg.

Results of surgical resection for hepatocellular carcinoma

Hepatogastroenterology.

Major hepatic resection. A 25-year experience

Ann Surg.

Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients

World J Surg.

Transection of the oesophagus for bleeding oesophageal varices

Br J Surg.