BACKGROUND: The extent of hepatectomy for solitary hepatocellular carcinoma (HCC) <5 cm is controversial. METHODS: This is a retrospective review of patients with solitary HCC <5 cm, who underwent liver resection in a tertiary referral centre in Hong Kong between January 1989 and December 2009. Baseline demographics, liver function, peri-operative outcomes, and overall survival were compared. RESULTS: A total of 348 cirrhotic patients with a solitary HCC <5 cm underwent either major hepatectomy (n = 93) or minor hepatectomy (n = 255). Child-Pugh status did not differ, 98.9 vs. 96.1 % (p = 0.319); all patients who underwent major and minor hepatectomy were classified as Child-Pugh status A. Patients who underwent major hepatectomy had a larger median tumor size (4.0 vs. 2.5 cm, p < 0.001) and they also had more advanced stage of disease (stage I/II/IIIa: 10.8/55.9/33.3 vs. 26.7/52.9/20.4 %, p = 0.002). Median operative time for major hepatectomy was significantly longer (415 vs. 248 min, p < 0.001) and entailed greater blood loss (0.9 vs. 0.5 l, p < 0.001). Despite larger tumor size and more advanced stage of disease in the major hepatectomy group, hospital mortality (5.4 vs. 2.0 %, p = 0.185), complication rates (30.1 vs. 23.1 %, p = 0.234), and transfusion rate (10.8 vs. 11.4 %, p = 0.862) were the same between the two groups. Overall survival was significantly better for those who underwent major hepatectomy, with a median survival of 147.5 vs. 92.1 months (p = 0.043), and they had a better 5- and 10-year disease-free survival rate (57.3 vs. 40.2, 38.1 vs. 18.9 %, p = 0.003). In subgroup analysis, the 10-year survival for patients with stage II HCC and tumor <5 cm was 68.6 vs. 36.6 % in those who received minor hepatectomy alone (p = 0.027). CONCLUSIONS: Major hepatectomy provided better long-term survival benefit in patients with HCC <5 cm, particularly in those with stage II disease.
BACKGROUND: The extent of hepatectomy for solitary hepatocellular carcinoma (HCC) <5 cm is controversial. METHODS: This is a retrospective review of patients with solitary HCC <5 cm, who underwent liver resection in a tertiary referral centre in Hong Kong between January 1989 and December 2009. Baseline demographics, liver function, peri-operative outcomes, and overall survival were compared. RESULTS: A total of 348 cirrhotic patients with a solitary HCC <5 cm underwent either major hepatectomy (n = 93) or minor hepatectomy (n = 255). Child-Pugh status did not differ, 98.9 vs. 96.1 % (p = 0.319); all patients who underwent major and minor hepatectomy were classified as Child-Pugh status A. Patients who underwent major hepatectomy had a larger median tumor size (4.0 vs. 2.5 cm, p < 0.001) and they also had more advanced stage of disease (stage I/II/IIIa: 10.8/55.9/33.3 vs. 26.7/52.9/20.4 %, p = 0.002). Median operative time for major hepatectomy was significantly longer (415 vs. 248 min, p < 0.001) and entailed greater blood loss (0.9 vs. 0.5 l, p < 0.001). Despite larger tumor size and more advanced stage of disease in the major hepatectomy group, hospital mortality (5.4 vs. 2.0 %, p = 0.185), complication rates (30.1 vs. 23.1 %, p = 0.234), and transfusion rate (10.8 vs. 11.4 %, p = 0.862) were the same between the two groups. Overall survival was significantly better for those who underwent major hepatectomy, with a median survival of 147.5 vs. 92.1 months (p = 0.043), and they had a better 5- and 10-year disease-free survival rate (57.3 vs. 40.2, 38.1 vs. 18.9 %, p = 0.003). In subgroup analysis, the 10-year survival for patients with stage II HCC and tumor <5 cm was 68.6 vs. 36.6 % in those who received minor hepatectomy alone (p = 0.027). CONCLUSIONS: Major hepatectomy provided better long-term survival benefit in patients with HCC <5 cm, particularly in those with stage II disease.
Authors: Donald Poon; Benjamin O Anderson; Li-Tzong Chen; Koichi Tanaka; Wan Yee Lau; Eric Van Cutsem; Harjit Singh; Wan Cheng Chow; London Lucien Ooi; Pierce Chow; Maung Win Khin; Wen Hsin Koo Journal: Lancet Oncol Date: 2009-11 Impact factor: 41.316
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Authors: Vincent S K Yip; Ronnie T P Poon; Kenneth S H Chok; Albert C Y Chan; Wing Chiu Dai; Simon H Y Tsang; See Ching Chan; Chung Mau Lo; Tan To Cheung Journal: World J Surg Date: 2015-11 Impact factor: 3.352
Authors: Emmanuel Gabriel; Jin Kim; Katherine T Ostapoff; Kristopher Attwood; Sergei Kurenov; Boris Kuvshinoff; Steven N Hochwald; Steven J Nurkin Journal: J Gastrointest Oncol Date: 2018-04