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New indication for reduction surgery in patients with advanced hepatocellular carcinoma with major vascular
Naoto Gotohda1, Taira Kinoshita, Masaru Konishi
1Department of Hepatobiliary Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan. ngotohda@east.ncc.go.jp
Insights
For advanced hepatocellular carcinoma with major vascular involvement, reductive resection offers similar survival to complete resection in patients with high prothrombin activity. Surgeons should consider reductive resection when complete resection is not feasible.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Advanced hepatocellular carcinoma (HCC) with tumor thrombi (TT) in major vessels has a poor prognosis.
- Multidisciplinary treatment approaches are crucial for managing these complex cases.
Purpose of the Study:
- To evaluate the efficacy of surgical resection, specifically reductive resection (RR), compared to other treatments for advanced HCC with major vascular involvement.
- To identify prognostic factors influencing survival in patients undergoing RR.
Main Methods:
- A consecutive series of 161 advanced HCC patients with major vascular involvement were analyzed.
- Treatment modalities included surgical resection (complete and reductive), radiotherapy, transcatheter arterial chemoembolization/infusion chemotherapy, systemic chemotherapy, and palliative therapy.
Main Results:
- Reductive resection (RR) showed a higher 1-year survival rate than other groups, excluding complete resection (CR).
- Prothrombin activity (PA) > 78% was a significant independent preoperative factor for overall survival in the RR group.
- Patients with PA > 78% undergoing RR had a median survival of 13.9 months, comparable to CR (9.1 months).
Conclusions:
- Reductive resection (RR) in advanced HCC patients with major vascular involvement and high prothrombin activity (>78%) yields survival rates similar to complete resection (CR).
- RR is a viable option for patients with high PA when CR is not feasible, guiding surgical decisions in multidisciplinary treatment.
Background:
The prognosis of advanced hepatocellular carcinoma (HCC) remains poor, particularly in patients with tumor thrombi (TT) in the major vessels.
Patients And Methods:
From July 1992 to October 2004, 161 patients diagnosed as having advanced HCC with major vascular involvement were seen consecutively at our hospital. Among these patients, 32 (20%) underwent surgical resection [16 complete resection (CR), 16 reductive resection (RR)]. Eighteen patients (11%) received radiotherapy (RT), 73 (45%) underwent transcatheter arterial chemoembolization (TACE) or transcatheter arterial infusion chemotherapy (TAI), 8 (5%) with distant metastases received systemic chemotherapy, and 30 (19%) received palliative therapy.
Results:
Excluding the CR group, the patients in the RR group had a higher 1-year survival rate than the other treatment groups. However, there was no significant difference in the overall survival rates of the RR, RT, and TACE/TAI groups. When we evaluated prognostic factors to clarify the indications for RR in the multidisciplinary treatment of patients with advanced HCC with TT, prothrombin activity (PA) was identified as a significant independent preoperative factor for overall survival in the RR group. The survival rate in patients with PA of < or = 78% was significantly lower than that of patients with PA of > 78% (P = 0.0004). The median survival time of patients with serum PA of > 78% who underwent RR was 13.9 months and that of patients who underwent CR was 9.1 months, with no survival difference between the groups.
Conclusion:
In advanced HCC with major vascular involvement, patients who had RR with PA of greater 78% achieved a similar survival to those who had CR. The surgeon should still proceed with RR in those patients with serum PA of > 78% if CR does not seem feasible on preoperative evaluation.