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Indications and results of resection for hepatocellular carcinoma
V Ziparo1, G Balducci, G Lucandri
1Department of Surgery 'Pietro Valdoni' University 'La Sapienza' Rome, Italy. vicenzo.ziparo@uniroma.it
Insights
Surgical treatment of hepatocellular carcinoma (HCC) using hepatic resection shows improved early outcomes with limited approaches. However, long-term survival remains challenging due to high recurrence rates, unaffected by surgical technique.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Hepatocellular Carcinoma (HCC) Research
Background:
- Hepatocellular carcinoma (HCC) is a significant global health concern.
- Surgical resection is a primary treatment modality for HCC.
- Evaluating surgical outcomes is crucial for improving patient management.
Purpose of the Study:
- To assess the early and long-term results of hepatic resections for HCC.
- To compare outcomes between different surgical approaches (anatomical vs. non-anatomical).
- To identify factors influencing patient survival and recurrence.
Main Methods:
- Retrospective analysis of 46 hepatic resections for HCC.
- Categorization into non-anatomical (n=28) and anatomical (n=18) resections.
- Assessment of mortality, morbidity, recurrence rates, and actuarial survival.
Main Results:
- Overall mortality and morbidity were 8.7% and 30.4%, respectively, with decreased rates in recent years.
- Hospital mortality was lower for non-anatomical resections (3.5%) compared to anatomical (16.6%).
- Recurrence was observed in 45.2% of patients, primarily intrahepatic; 3-, 5-, and 10-year survival rates were 62%, 51.1%, and 22.5%.
Conclusions:
- Limited surgical approaches may improve early outcomes in HCC resection.
- Long-term survival remains unsatisfactory due to high recurrence rates.
- Surgical approach does not significantly influence long-term recurrence rates in HCC.
Aim:
In this retrospective series we evaluate our experience in surgical treatment of HCC and examine early and long-term results of 46 hepatic resections.
Methods:
Eighty-eight patients with HCC have been observed at our Department. Fifty patients (57%) have been operated, but only 46 (92%) could be resected; 43 patients (93.5%) carried liver cirrhosis. We performed 28 non-anatomical resections (60.8%) and 18 anatomical resections (39.2%). Tumour clearance at resection margin of at least 1cm was considered for a curative resections.
Results:
Overall mortality and morbidity were 8.7 and 30.4% respectively. These rates significantly decreased in the last years: from 1995 to 2000 no hospital mortality has been recorded. Hospital mortality among non-anatomical and anatomical resection subgroups was 3.5 and 16.6% respectively (P<0.02). After a median f.u. of 41 months, 19 patients (45.2%) had recurrences: it was intrahepatic in 16 (84.4%). We observed a 3-, 5- and 10-years actuarial survival rate 62, 51.1 and 22.5% respectively. Long term survival significantly differed between non-anatomical and anatomical resections, with 5-year and 10-year values of 61.1 and 34.3% vs 37.7 and 18.8% respectively (P=0.0224).
Conclusions:
Early results after hepatic resection for HCC can be improved by using a limited surgical approach. Long-term results are still unsatisfactory, because of the high recurrence rate that is not influenced by different surgical approaches.