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Is Liver Resection Justified in Advanced Hepatocellular Carcinoma? Results of an Observational Study in 464 Patients

  • 2008 SSAT Quickshot Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background and Objective

The role of liver resection in advanced hepatocellular carcinoma (multinodular or with macroscopic vascular involvement) is still controversial. The aim of this study is to evaluate the role of surgical resection compared to other therapeutic modalities in patients with advanced hepatocellular carcinoma (HCC).

Methods

Four hundred sixty four patients with HCC observed from 1991 to 2007 were included in the study. All the patients were evaluated for the treatment of HCC in relation to the severity of liver impairment and tumor stage. All the patients included in the study had no evidence of distant metastases.

Results

Median follow up time for surviving patients was 25 months (range 1–155). Two-hundred and eighty-three patients were in Child–Pugh class A, 161 in class B, and 20 in class C. Two-hundred and seventy-one patients had single HCC, 121 patients had two or three HCCs, and 72 more than three HCCs. One-hundred and thirty-six patients (29.3%) were submitted to liver resection (LR), 232 (50.0%) to local ablative therapies (LAT) (ethanol injection, radiofrequency ablation, chemoembolization), eight (1.7%) to liver transplantation (LT), and 88 (19%) to supportive therapy (ST). Median survival time for all patients was 36 months (95% CI 24–36). Median survival time was 57 months for LR, 30 months for LAT, and 8 months for ST, with a 5-year survival of 47%, 20%, and 2.5%, respectively (p = 0.001). Actuarial 5-year survival for patients submitted to LT was 75%. Overall survival was significantly shorter in patients with multiple HCCs compared to single HCC, with median survival times of 39, 16, and 11 months for patients with a single HCC, with two to three HCCs, and with more than three HCCs, respectively (p = 0.01). Survival for patients with single HCC was significantly longer in patients submitted to LR compared to LAT and ST with median survival times of 57, 37, and 14 months, respectively (p = 0.02). Also, in patients with multinodular HCCs (2–3 HCCs) LR showed the best results with a median survival time of 58 months compared to 22 and 8 months for LAT and ST (p = 0.01). In patients with more than three HCCs, LR did not show different results compared to LAT and ST. Seventy-three patients had evidence of macroscopic vascular involvement; median survival in this subgroup of patients was significantly shorter compared to patients without vascular involvement, 10 and 36 months, respectively. Survival for patients with macroscopic vascular involvement submitted to LR or LAT was significant longer compared to ST, with mean survivals of 27, 30, and 12 months, respectively (p = 0.01).

Conclusions

The present study shows that the surgery can achieve good results in patients with single HCC and good liver function. Also, patients with multinodular HCCs (two to three nodules) could benefit from LR where survival is longer than after LAT or ST. In patients with more than three HCCs, LR have similar results of LAT. Macroscopic vascular invasion is a major prognostic factor, and the LR is justified in selected patients, where it can allow good long-term results compared to ST.

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Authors and Affiliations

  1. Department of Surgery and Gastroenterology, Division of General Surgery “A”, GB Rossi University Hospital, University of Verona Medical School, Piazzale LA Scuro 10, 37134, Verona, Italy

    Andrea Ruzzenente, Silvia Pachera, Calogero Iacono, Gianluca Piccirillo, Alessandro Valdegamberi & Alfredo Guglielmi

  2. Department of Biomedical and Surgical Science, University of Verona Medical School, Verona, Italy

    Franco Capra & Marta Lunardi

  3. Department of Internal Medicine, Desenzano Hospital, Desenzano, Italy

    Stefano Pistoso

  4. Department of Radiology, University of Verona Medical School, Verona, Italy

    Mirko D’Onofrio

Authors
  1. Andrea Ruzzenente
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  2. Franco Capra
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  3. Silvia Pachera
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  4. Calogero Iacono
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  5. Gianluca Piccirillo
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  6. Marta Lunardi
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  7. Stefano Pistoso
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  8. Alessandro Valdegamberi
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  9. Mirko D’Onofrio
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  10. Alfredo Guglielmi
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Corresponding author

Correspondence to Andrea Ruzzenente.

Additional information

This study was presented as Quick Shot oral presentation of the Surgical Society Alimentary Tract at Digestive Disease Week, May 20, 2008, San Diego Convention Center, San Diego, CA, USA and as oral presentation at 23rd Annual SSAT Residents & Fellows Research Conference, May 17, 2008, Omni San Diego, San Diego, CA.

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Ruzzenente, A., Capra, F., Pachera, S. et al. Is Liver Resection Justified in Advanced Hepatocellular Carcinoma? Results of an Observational Study in 464 Patients. J Gastrointest Surg 13, 1313–1320 (2009). https://doi.org/10.1007/s11605-009-0903-x

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  • DOI: https://doi.org/10.1007/s11605-009-0903-x

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