Original CommunicationsExtent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma*
Section snippets
Patient selection
From January 1990 (availability of hepatitis C serology at our institution) to December 1996 (period for appropriate follow-up), data from 193 patients with HCC who underwent liver resection had been reviewed. Among 92 patients with a small HCC (4 cm or less), 28 patients were excluded for 1 or more of the following reasons: absence of cirrhosis, severely impaired liver function (Child-Pugh score B and C), palliative liver resection, resection margin < 1 cm, ruptured tumor, multiple tumors, and
Operative variables
The number of patients who underwent resection under Pringle's maneuver was not statistically different between limited (30/34, 88%) and anatomic resection groups (25/30, 83%). The mean total duration of vascular clamping between limited and anatomic resection groups was not significantly different: 35 ± 19 minutes (range 6-75 minutes) versus 30 ± 15 minutes (range 5-75 minutes). Intraoperative bleeding was not significantly different between limited and anatomic groups (670 ± 773 mL vs 844 ±
Discussion
This study showed that in selected patients with cirrhosis and Child-Pugh score A, all presenting a small HCC (≤ 4 cm), anatomic resections, and attempted removal of the tumor and its portal territory achieved better long-term and disease-free survival than those who underwent limited resections, without increasing the postoperative risk.
It is known that major factors influencing survival after resection of HCC include liver function, tumor characteristics, underlying liver disease, and type of
Conclusion
This study showed that anatomic resections, including the tumor and its adjacent portal territory, improve overall and disease-free survivals of patients with cirrhosis presenting a small HCC. Therefore, we suggest considering this oncologic surgical concept as standard treatment for small HCC in patients with cirrhosis with good liver function. Consequently, in our institution, when anatomical resection does not seem possible because of either the tumor location or the degree of the liver
References (31)
- et al.
Hepatic resection for hepatocellular carcinoma
Am J Surg
(1997) - et al.
Prognosis of recurrent hepatocellular carcinoma: a 10-year surgical experience in Japan
Gastroenterology
(1996) - et al.
Surgical resection for small hepatocellular carcinoma
Surgery
(1996) - et al.
Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial
Lancet
(2000) - et al.
Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis. A study on 207 patients
Cancer
(1992) - et al.
Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis
Ann Surg
(2000) - et al.
Radiofrequency ablation of porcine liver in vivo: effects of blood flow and treatment time on lesion size
Ann Surg
(1998) - et al.
Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients
Ann Surg
(1993) - et al.
Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis
N Engl J Med
(1996) - et al.
Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation
Hepatology
(1999)
An analysis of 412 cases of hepatocellular carcinoma at a Western center
Ann Surg
The prognostic significance of surgical margin in liver resection of patients with hepatocellular carcinoma
Arch Surg
Retrospective analysis of type of hepatic resection for hepatocellular carcinoma
Br J Surg
Prognostic factors affecting long-term outcome after liver resection for hepatocellular carcinoma: results in a series of 100 Italian patients
Cancer
Surgical margin and recurrence after resection of hepatocellular carcinoma in patients with cirrhosis. Further evaluation of limited hepatic resection
Ann Surg
Cited by (277)
Anatomic versus non-anatomic resection of hepatocellular carcinoma with microvascular invasion: A systematic review and meta-analysis
2021, Asian Journal of SurgeryCitation Excerpt :Several studies have reported that AR is associated with better overall survival (OS) and disease-free survival (DFS) in HCC patients.5 AR involves resecting a segment or subsegment of the liver, including major branches of the portal vein and hepatic arteriovenous system,6 and allows for effective removal of the entire tumor burden and hepatic areas at high risk of intrahepatic micrometastasis or MVI.7 However, to reduce the risk of vascular invasions and subnodules, a greater surface area of liver tissue is sacrificed in AR, which is unfavorable in patients with underlying liver disease.8
Comparison of anatomic and non-anatomic resections for very early-stage hepatocellular carcinoma: The importance of surgical resection margin width in non-anatomic resection
2021, Surgical OncologyCitation Excerpt :However, a western study of two centers has reported that AR for HCC of diameter ≤2 cm is associated with better outcome [3]. Other researchers have also found AR to be beneficial for early-stage HCC [7,22–24]. Most of the studies were retrospective, and the results were potentially confounded by selection bias.
- *
Reprint requests: Jacques Belghiti, MD, Department of Hepatobiliary and Digestive Surgery, Beaujon Hospital, 92 118 Clichy Cédex, France.