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Hepatocellular carcinoma confined to Couinaud segment VIII: experience with extensive or limited resection
Chung-Wei Lin1, Gar-Yang Chau, Wing-Yiu Lui
1Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Insights
Extensive resection for hepatocellular carcinoma (HCC) in segment VIII offers better survival outcomes. This approach in selected patients leads to improved disease-free survival and tumor marker normalization compared to limited resection.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) surgical treatment in Couinaud segment VIII is challenging.
- This study investigates outcomes of extensive versus limited resection for segment VIII HCC.
Purpose of the Study:
- To evaluate surgical and oncological results of extensive resection versus limited resection for HCC confined to segment VIII.
- To compare outcomes between different resection strategies in this specific HCC location.
Main Methods:
- Retrospective analysis of 36 patients with segment VIII HCC who underwent hepatic resection.
- Patients were divided into two groups: extensive resection (n=15) and limited resection (n=21).
Main Results:
- Extensive resection group had larger tumors, heavier specimens, and wider surgical margins (p<0.05).
- Higher rates of normal a-fetoprotein levels post-resection and significantly better 1-, 3-, and 5-year disease-free survival were observed in the extensive resection group (p=0.021).
- Hospital mortality and morbidity showed no significant difference between groups (p>0.05).
Conclusions:
- Extensive resection in selected patients with HCC in segment VIII is associated with improved survival.
- This surgical approach may offer better oncological control for segment VIII HCC.
Background/Aims:
Surgical treatment of hepatocellular carcinoma (HCC) confined to Couinaud segment VIII has been regarded as difficult. This study evaluates surgical and oncological results after extensive or limited resection of the tumor(s).
Methodology:
Of the 399 HCC patients that underwent hepatic resection, 36 patients had the tumor(s) confined to segment VIII. These 36 patients were divided into group 1 (extensive resection) (n=15) (three right hepatectomies, 12 anterior segmentectomies) and group 2 (limited resection) (n=21) (11 subsegmentectomies, 10 wedge resections). Data were collected prospectively and analyzed retrospectively.
Results:
Hospital mortality and morbidity were 0% and 20% in group 1, 9.5%, and 38% in group 2 (P>0.05). Group 1 patients had larger tumor (4.0cm vs. 2.8cm; P=0.01), heavier resected specimen (380g vs. 118g; P<0.01), and a higher incidence of wide surgical margin (> or =1cm) (67% vs. 29%; P=0.041) than those in group 2. The percentage of patients in whom the a-fetoprotein levels returned to the normal range after resection was higher in group 1 (75.0%, 6 of 8 patients) than in group 2 (26.7%, 4 of 15 patients) (P=0.037). The 1-, 3-, and 5-year disease-free survival in group 1 (93%, 79% and 52%) were significantly better than those of group 2 (67%, 38% and 22%) (P=0.021).
Conclusions:
In selected patients, extensive resection of HCC located in segment VIII correlates with better survival.