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Surgical Resection for Hepatocellular Carcinoma with Concomitant Esophageal Varices

Noboru Harada1, Ken Shirabe, Takashi Maeda

  • 1Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, 730-8619, Japan, nharada@surg2.med.kyushu-u.ac.jp.

World Journal of Surgery
|June 11, 2015
PubMed

Insights

Hepatocellular carcinoma (HCC) patients with esophageal varices (EV) have lower survival after hepatectomy. Surgery may be suitable for HCC patients with EV and good liver function (ICGR15 ≤17%), but those with specific variceal signs require careful management.

Area of Science:

  • Hepatobiliary surgery
  • Gastroenterology
  • Surgical oncology

Background:

  • Management of hepatocellular carcinoma (HCC) in patients with concurrent esophageal varices (EV) is complex.
  • Hepatectomy is a potential curative treatment for HCC, but the presence of EV poses risks.
  • Assessing surgical outcomes and identifying risk factors is crucial for patient selection and management.

Purpose of the Study:

  • To evaluate the surgical outcomes of hepatectomy in HCC patients with and without concomitant EV.
  • To clarify the indications for hepatectomy in HCC patients with EV.
  • To identify risk factors for EV bleeding post-hepatectomy.

Main Methods:

  • Retrospective analysis of 502 patients with HCC who underwent curative hepatectomy.
  • Comparison of prognostic outcomes between patients with and without EV.
  • Multivariate analysis to identify predictors of overall survival and EV bleeding.

Main Results:

  • Overall survival was significantly lower in HCC patients with EV compared to those without (p=0.003).
  • Indocyanine green retention test at 15 min (ICGR15) >17% and alpha-fetoprotein >12.5 ng/ml predicted poorer overall survival.
  • Preoperative endoscopic findings of blue color EV and red color sign predicted EV bleeding post-hepatectomy.

Conclusions:

  • HCC patients with EV and ICGR15 ≤17% may be candidates for hepatectomy.
  • Careful management is needed for HCC patients with EV who exhibit blue color or red color signs endoscopically.
  • Risk stratification using liver function tests and endoscopic findings is essential for surgical decision-making.
Abstract

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