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. 2013 Jan;15(1):31-9.
doi: 10.1111/j.1477-2574.2012.00552.x. Epub 2012 Aug 26.

Risk factors of post-operative recurrence and adequate surgical approach to improve long-term outcomes of hepatocellular carcinoma

Junichi Shindoh  1 , Kiyoshi Hasegawa, Yosuke Inoue, Takeaki Ishizawa, Rihito Nagata, Taku Aoki, Yoshihiro Sakamoto, Yasuhiko Sugawara, Masatoshi Makuuchi, Norihiro Kokudo
Affiliations

Risk factors of post-operative recurrence and adequate surgical approach to improve long-term outcomes of hepatocellular carcinoma

Junichi Shindoh et al. HPB (Oxford). 2013 Jan.

Abstract

Introduction: A high recurrence rate of hepatocellular carcinoma (HCC) remains a significant concern. The risk factors for recurrence were analysed and the optimal surgical approaches were investigated.

Methods: The subjects comprised 280 consecutive patients with primary solitary HCC measuring ≤5 cm in diameter, who underwent curative resections. Multivariate analysis was conducted to identify the risk factors for post-operative recurrence, and the clinical significance of an anatomic resection was evaluated.

Results: Multivariate analysis identified HCV infection, a des-gamma-carboxyprothrombin level >100 mAU/ml, underlying cirrhosis, the presence of microvascular invasion, the presence of micrometastases and non-anatomic resection as being significant risk factors for post-operative recurrence. The 5-year recurrence rate was 56.7% in the anatomic resection (AR) group and 74.7% in the non-AR group. The 5-year survival rate was 82.2% in the AR group and 71.9% in the non-AR group. Local recurrence within the same segment was observed in 25% of the patients of the non-AR group. The prognostic superiority of AR was confirmed only in patients with histopathological evidence of microvascular invasion and/or micrometastases, and in patients having a solitary HCC measuring 2 to 5 cm in diameter.

Conclusions: Anatomic resection may decrease local recurrence and improve the surgical outcomes in solitary HCC measuring 2 to 5 cm in diameter.

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Figures

Figure 1
Figure 1
Long-term outcomes in patients treated by anatomic resection and non-anatomic resection. (a) overall survival; (b) recurrence rate. AR: anatomic resection; non-AR: non-anatomic resection
Figure 2
Figure 2
Comparison of the recurrence rate among patients with local recurrence after non-anatomic resection, patients without local recurrence after non-anatomic resection and patients treated by anatomic resection. AR: anatomic resection; non-AR: non-anatomic resection
Figure 3
Figure 3
Comparison of the recurrence rates in subsets of the AR and non-AR groups. (a) microscopic cancer spread (-); (b) microscopic cancer spread (+); (c) hepatocellular carcinoma (HCC) measuring ≤2 cm in diameter; (d) HCC measuring 2 to 5 cm in diameter. AR: anatomic resection; non-AR: non-anatomic resection
See this image and copyright information in PMC

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