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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 1999 June;12(3):165-72
Long-term results in the surgical treatment of hepatocellular carcinoma. An analysis of prognostic factors
Ialongo P., Spiliopoulos G., Campion J.P., Launois B.
Background. Great progress in the diagnosis and surgical treatment of hepatocellular carcinoma (HCC) has led to an increased number of resectable cases. The outcomes of patients with hepatocellular carcinoma who underwent liver resection are analyzed and much attention has been paid to the factors affecting long term survival.
Methods. Between January 1974 and December 1995, 207 patients were operated on for HCC at the Department of Digestive Surgery and Transplantation Unit, Hopital Pontchaillou, University of Rennes (France). There were 185 men and 22 women with a median age of 60 years (range 48-72). In 149 cases (72%) HCC developed in a cirrhotic liver.
Results. Resectability rate was 65.7%. Overall operative mortality was 8.2% and 9.4% and 5.2% in cirrhotic and noncirrhotic patients respectively (p=NS). The 1-,3- and 5 year survivals in cirrhotic and noncirrhotic patients were 70, 43.1, 21.7% and 81, 50, 28.6% respectively (p=NS). Predictive factors for long term prognosis after partial hepatectomy were as follows: alpha-fetoprotein level (alfaFP) <15 ng/ml (p<0.0001), number of tumors <2 (p<0.05), surgical margin >1 cm (p<0.001), operative haemodynamic stability (p=0.04). Furthermore, survival was better in patients without invasion of surgical margin (p<0.0001), preoperative symptomatology (p=0.008), portal hypertension (p=0.01), postoperative complications, peroperative transfusions of plasma (p=0.01) or blood (packed erythrocytes) >1 unit (p=0.02) and operated after 1990 (p<0.05).
Conclusions. Hepatectomy offers the best hope of treatment in patients with HCC. Survival is improved by appropriate selection of patients (alfaFP<15 ng/ml, number of tumors <2, without preoperative symptomatology or portal hypertension) and by operative technique (intrahepatic posterior approach to the portal triad) that allows hepatectomies ''réglées'' and with surgical margin >1 cm, without blood or plasma transfusion.