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Hepatic resection for small hepatocellular carcinoma: the Queen Mary Hospital experience
Insights
This study on small hepatocellular carcinoma (HCC) found limited hepatectomy to be the preferred surgical approach. A 1 cm resection margin ensures complete clearance, with outcomes comparable to larger HCC tumors.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Small hepatocellular carcinoma (HCC) presents unique clinical and pathological features.
- Understanding long-term outcomes for resected small HCC is crucial for treatment planning.
Purpose of the Study:
- To evaluate the clinico-pathological features and long-term results of patients with resected small HCC.
- To compare outcomes of small HCC with large HCC and assess the impact of resection extent.
Main Methods:
- Retrospective study of 39 patients with resected small HCC over 19 years.
- Analysis of clinico-pathological data, surgical procedures (major lobectomy vs. limited resection), and survival rates.
- Comparison with 182 patients with large HCC.
Main Results:
- Small HCC (mean diameter 3.6 cm) showed higher rates of spontaneous rupture compared to large HCC.
- Overall 1, 3, and 5-year survival rates were 59%, 28%, and 11%, comparable to large HCC.
- No significant difference in long-term outcome based on tumor size (>3 cm vs. <=3 cm) or extent of hepatectomy.
- Small HCC exhibited more frequent encapsulation and less venous permeation than large HCC.
Conclusions:
- Limited hepatectomy is likely the optimal procedure for small HCC due to similar long-term outcomes regardless of resection extent.
- A 1 cm macroscopic resection margin appears sufficient for complete histological clearance.
- Small HCC has distinct pathological features, including frequent encapsulation and less venous permeation.
Abstract:
The clinico-pathological features and long-term results of 39 patients with resected small hepatocellular carcinoma (HCC) managed over 19 years in Hong Kong were retrospectively studied (mean diameter +/- standard deviation: 3.6 +/- 1.3 cm). Thirty-one patients were symptomatic and the majority (n = 33) of them had cirrhosis. When compared with 182 patients with large HCC operated within the same period, these patients with small HCC had a significantly higher incidence of spontaneously ruptured lesions (p less than 0.03). Following hepatic resection-major lobectomy (n = 19) and limited hepatic resection (n = 20), operative and hospital deaths occurred in 7.7% and 12.8% of patients, respectively. The size of the lesion had little influence on prognosis. The overall survival at 1, 3, and 5 years was 59%, 28%, and 11%, respectively, which was comparable to patients with large HCC greater than or equal to 5 cm. Further stratification of these 39 patients according to a diameter of greater than 3 cm (n = 22) or less than or equal to 3 cm (n = 17) showed no difference in long-term outcome. When compared with large tumors, frequent encapsulation (p less than 0.04) and less venous permeation (p less than 0.03) were encountered in small HCC. As the extent of hepatectomy had no effect on long-term outcome, limited hepatectomy for patients with small HCC is probably the procedure of choice. A 1 cm macroscopic resection margin is apparently adequate to ensure complete histological disease clearance.