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Perioperative Factors Affecting Long-Term Outcomes of 473 Consecutive Patients Undergoing Hepatectomy for Hepatocellular Carcinoma

  • Hepatobiliary and Pancreatic Tumors
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Abstract

Background

The aim of this study was to evaluate the long-term outcomes of liver resection for hepatocellular carcinoma (HCC).

Methods

Between January 1993 and December 2002, a total of 473 patients underwent hepatectomy for HCC at a medical center in Taiwan. Clinicopathological and surgical characteristics were studied to identify prognostic factors influencing survival.

Results

There were 379 men (80.1%) with mean ± standard deviation age of 53.1 ± 13.1 years. The etiology of HCC was hepatitis B (n = 277), hepatitis C (n = 90), coinfection with hepatitis B and C (n = 47), and non–B or C hepatitis (n = 50). The blood loss was 282.3 ± 370.5 ml, and 411 patients (86.9%) did not require perioperative blood transfusion. On univariate analysis, the statistically significant independent factors for disease-free survival were alfa-fetoprotein (AFP) levels of >400 ng/ml, indocyanine green retention of >10%, Pringle maneuver, blood transfusion, tumor diameter >5 cm, bilateral tumors, microvascular invasion, adjacent tissue invasion, daughter nodules and cirrhotic liver. The univariate factors influencing overall survival were similar to those influencing disease-free survival except for AFP. Independent factors that statistically significantly affected overall survival on multivariate analysis included Pringle maneuver, blood transfusion, tumor diameter >3 cm, microvascular invasion, daughter nodules, and liver cirrhosis. The 1-, 5-, and 10-year disease-free survival were 75.3, 43.3, and 22.3%, respectively. The 1-, 5-, and 10-year overall survival were 86.7, 55, and 33.7%, respectively.

Conclusions

AFP, indocyanine green retention of >10%, blood transfusion, Pringle maneuver, tumor diameter of >3 cm, bilateral tumors, microvascular invasion, adjacent tissue invasion, daughter nodules, and liver cirrhosis influence survival.

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Acknowledgment

We thank the following people for their invaluable help in contributing to this study: Yueh-Wei Liu, MD, Chin-Hsiang Yang, MD, Chee-Chien Yong, MD, Allan M. Concejero, MD, and Chien-Mo Lee, MD, for their contribution to patient data; Bruno Jawan, MD, for his help with anaesthesia; Yu-Fan Cheng, MD, for radiological and intervention support; and Hock-Liu Eng, MD, for analyzing the pathologic specimens.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Liver Transplant Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Niao-Sung, Kaohsiung, Taiwan

    Chih-Chi Wang MD, Shridhar G. Iyer FRCS, Jee Keem Low MD, FRCS, Shih-Ho Wang MD & Chao-Long Chen MD

  2. Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Niao-Sung, Kaohsiung, Taiwan

    Chih-Yun Lin MS & Sen-Nan Lu MD

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  1. Chih-Chi Wang MD
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  2. Shridhar G. Iyer FRCS
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Correspondence to Chao-Long Chen MD.

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Wang, CC., Iyer, S.G., Low, J.K. et al. Perioperative Factors Affecting Long-Term Outcomes of 473 Consecutive Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. Ann Surg Oncol 16, 1832–1842 (2009). https://doi.org/10.1245/s10434-009-0448-y

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