Surgical resection for small hepatocellular carcinoma

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Liver Transplantation

Background:

• Surgical resection offers a curative option for select patients with small hepatocellular carcinoma (s-sHCC), defined as 2 cm or less in diameter.
• Despite curative resection, patients with s-sHCC face risks of tumor recurrence and mortality due to underlying liver dysfunction.
• Identifying clinicopathologic factors influencing long-term prognosis after s-sHCC resection is essential.

Purpose of the Study:

• To determine clinicopathologic features associated with long-term prognosis in patients who underwent surgical resection for solitary small hepatocellular carcinoma (s-sHCC).

Main Methods:

• Partial hepatectomy was performed on 50 patients with s-sHCC between 1977 and 1992.
• Eight clinicopathologic features were analyzed in the 44 surviving patients using univariate and multivariate analyses to assess their impact on long-term prognosis.

Main Results:

• Overall 1-, 3-, and 5-year survival rates were 90%, 75%, and 53%, respectively.
• Disease-free survival rates at 1, 3, and 5 years were 80%, 53%, and 30%, respectively.
• Complicated liver function was the sole significant predictor of both survival and disease-free survival; other factors like vascular invasion, margin distance, and preoperative embolization were not significant.

Conclusions:

• Adequate hepatic reserve is a critical determinant for successful long-term outcomes following surgical resection of s-sHCC.
• Liver transplantation should be strongly considered for patients with severe cirrhosis and s-sHCC, even when curative resection appears feasible.