Chetana Lim1,2, Philippe Compagnon1,3, Mylène Sebagh4, Chady Salloum1, Julien Calderaro1,3, Alain Luciani1,3, Gérard Pascal1, Alexis Laurent1,3, Eric Levesque1,3, Umberto Maggi1,5, Cyrille Feray1,3, Daniel Cherqui4, Denis Castaing4, Daniel Azoulay1,3. 1. Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France. 2. Unité 965, Institut National de la Santé et de la Recherché Médicale (Inserm) (National Institute for Health and Medical Research), Paris, France. 3. Unité 955, Inserm, Créteil, France. 4. Centre Hépato-Biliaire (Hepatobiliary Centre), AP-HP Hôpital Paul Brousse, Villejuif, France. 5. Hepatobiliary Surgery and Liver Transplant Unit, Ospedale Maggiore Policlinico Milano, Milano, Italy.
Abstract
OBJECTIVES: Appropriate patient selection is important to achieving good outcomes and obviating futile surgery in patients with huge (≥10 cm) hepatocellular carcinoma (HCC). The aim of this study was to identify independent predictors of futile outcomes, defined as death within 3 months of surgery or within 1 year from early recurrence following hepatectomy for huge HCC. METHODS: The outcomes of 149 patients with huge HCCs who underwent resection during 1995-2012 were analysed. Multivariate logistic regression analysis was performed to identify preoperative independent predictors of futility. RESULTS: Independent predictors of 3-month mortality (18.1%) were: total bilirubin level >34 μmol/l [P = 0.0443; odds ratio (OR) 16.470]; platelet count of <150 000 cells/ml (P = 0.0098; OR 5.039), and the presence of portal vein tumour thrombosis (P = 0.0041; OR 5.138). The last of these was the sole independent predictor of 1-year recurrence-related mortality (17.2%). Rates of recurrence-related mortality at 3 months and 1 year were, respectively, 6.3% and 7.1% in patients with Barcelona Clinic Liver Cancer (BCLC) stage A disease, 12.5% and 14% in patients with BCLC stage B disease, and 37.8% (P = 0.0002) and 75% (P = 0.0002) in patients with BCLC stage C disease. CONCLUSIONS: According to the present data, among patients submitted to hepatectomy for huge HCC, those with a high bilirubin level, low platelet count and portal vein thrombosis are at higher risk for futile surgery. The presence of portal vein tumour thrombosis should be regarded as a relative contraindication to surgery.
OBJECTIVES: Appropriate patient selection is important to achieving good outcomes and obviating futile surgery in patients with huge (≥10 cm) hepatocellular carcinoma (HCC). The aim of this study was to identify independent predictors of futile outcomes, defined as death within 3 months of surgery or within 1 year from early recurrence following hepatectomy for huge HCC. METHODS: The outcomes of 149 patients with huge HCCs who underwent resection during 1995-2012 were analysed. Multivariate logistic regression analysis was performed to identify preoperative independent predictors of futility. RESULTS: Independent predictors of 3-month mortality (18.1%) were: total bilirubin level >34 μmol/l [P = 0.0443; odds ratio (OR) 16.470]; platelet count of <150 000 cells/ml (P = 0.0098; OR 5.039), and the presence of portal vein tumour thrombosis (P = 0.0041; OR 5.138). The last of these was the sole independent predictor of 1-year recurrence-related mortality (17.2%). Rates of recurrence-related mortality at 3 months and 1 year were, respectively, 6.3% and 7.1% in patients with Barcelona Clinic Liver Cancer (BCLC) stage A disease, 12.5% and 14% in patients with BCLC stage B disease, and 37.8% (P = 0.0002) and 75% (P = 0.0002) in patients with BCLC stage C disease. CONCLUSIONS: According to the present data, among patients submitted to hepatectomy for huge HCC, those with a high bilirubin level, low platelet count and portal vein thrombosis are at higher risk for futile surgery. The presence of portal vein tumour thrombosis should be regarded as a relative contraindication to surgery.
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Authors: Francesco Esposito; Chetana Lim; Chady Salloum; Michael Osseis; Eylon Lahat; Philippe Compagnon; Daniel Azoulay Journal: Ann Hepatobiliary Pancreat Surg Date: 2017-08-31