Zhen-Li Li1, Jiong-Jie Yu1, Jun-Wu Guo1, Cheng-Jun Sui1, Bing-Hua Dai1, Wan-Guang Zhang2, Ting-Hao Chen3, Chao Li1, Wei-Min Gu4, Ya-Hao Zhou5, Hong Wang6, Yao-Ming Zhang7, Xian-Hai Mao8, Timothy M Pawlik9, Ming-Da Wang1, Lei Liang1, Han Wu1, Wan Yee Lau10, Meng-Chao Wu1, Feng Shen11, Tian Yang12. 1. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. 2. Department of Hepatic Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China. 3. Department of General Surgery, Ziyang First People's Hospital, Sichuan, China. 4. The First Department of General Surgery, Fourth Hospital of Harbin, Heilongjiang, China. 5. Department of Hepatobiliary Surgery, Pu'er People's Hospital, Yunnan, China. 6. Department of General Surgery, Liuyang People's Hospital, Hunan, China. 7. The Second Department of Hepatobiliary Surgery, Meizhou People's Hospital, Guangdong, China. 8. Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Hunan, China. 9. Department of Surgery, Ohio State University, Wexner Medical Center, Columbus, OH, United States. 10. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China. 11. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. Electronic address: shenfengehbh@sina.com. 12. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. Electronic address: yangtianehbh@smmu.edu.cn.
Abstract
BACKGROUND: The role of liver resection for multinodular (≥3 nodules) hepatocellular carcinoma (HCC) remains unclear, especially among patients with severe underlying liver disease. We sought to evaluate surgical outcomes among patients with cirrhosis and multinodular HCC undergoing liver resection. METHODS: Using a multicenter database, outcomes among cirrhotic patients who underwent curative-intent resection of HCC were examined stratified according to the presence or absence of multinodular disease. Perioperative mortality and morbidity, as well as overall survival (OS) and recurrence-free survival (RFS) were compared between the two groups. RESULTS: Among 1066 cirrhotic patients, 906 (85.0%) had single- or double-nodular HCC (the non-multinodular group), while 160 (15.0%) had multinodular HCC (the multinodular group). There were no differences in postoperative 30-day mortality and morbidity among non-multinodular versus multinodular patients (1.8% vs. 1.9%, P = 0.923, and 36.0% vs. 39.4%, P = 0.411, respectively). In contrast, 5-year OS and RFS of multinodular patients were worse compared with non-multinodular patients (34.6% vs. 58.2%, and 24.7% vs. 44.5%, both P < 0.001). On multivariable analyses, tumor numbers ≥5, total tumor diameter ≥8 cm and microvascular invasion were independent risk factors for decreased OS and RFS after resection of multinodular HCC in cirrhotic patients. CONCLUSIONS: Liver resection can be safely performed for multinodular HCC in the setting of cirrhosis with an overall 5-year survival of 34.6%. Tumor number ≥5, total tumor diameter ≥8 cm and microvascular invasion were independently associated with decreased OS and RFS after resection in cirrhotic patients with multinodular HCC.
BACKGROUND: The role of liver resection for multinodular (≥3 nodules) hepatocellular carcinoma (HCC) remains unclear, especially among patients with severe underlying liver disease. We sought to evaluate surgical outcomes among patients with cirrhosis and multinodular HCC undergoing liver resection. METHODS: Using a multicenter database, outcomes among cirrhotic patients who underwent curative-intent resection of HCC were examined stratified according to the presence or absence of multinodular disease. Perioperative mortality and morbidity, as well as overall survival (OS) and recurrence-free survival (RFS) were compared between the two groups. RESULTS: Among 1066 cirrhotic patients, 906 (85.0%) had single- or double-nodular HCC (the non-multinodular group), while 160 (15.0%) had multinodular HCC (the multinodular group). There were no differences in postoperative 30-day mortality and morbidity among non-multinodular versus multinodularpatients (1.8% vs. 1.9%, P = 0.923, and 36.0% vs. 39.4%, P = 0.411, respectively). In contrast, 5-year OS and RFS of multinodularpatients were worse compared with non-multinodular patients (34.6% vs. 58.2%, and 24.7% vs. 44.5%, both P < 0.001). On multivariable analyses, tumor numbers ≥5, total tumor diameter ≥8 cm and microvascular invasion were independent risk factors for decreased OS and RFS after resection of multinodular HCC in cirrhotic patients. CONCLUSIONS: Liver resection can be safely performed for multinodular HCC in the setting of cirrhosis with an overall 5-year survival of 34.6%. Tumor number ≥5, total tumor diameter ≥8 cm and microvascular invasion were independently associated with decreased OS and RFS after resection in cirrhotic patients with multinodular HCC.
Authors: Saleh A Alqahtani; Faisal M Sanai; Ashwaq Alolayan; Faisal Abaalkhail; Hamad Alsuhaibani; Mazen Hassanain; Waleed Alhazzani; Abdullah Alsuhaibani; Abdullah Algarni; Alejandro Forner; Richard S Finn; Waleed K Al-Hamoudi Journal: Saudi J Gastroenterol Date: 2020-10 Impact factor: 2.485
Authors: Ismail Labgaa; Patrick Taffé; David Martin; Daniel Clerc; Myron Schwartz; Norihiro Kokudo; Alban Denys; Nermin Halkic; Nicolas Demartines; Emmanuel Melloul Journal: Liver Cancer Date: 2020-01-28 Impact factor: 11.740