Liver resection for hepatocellular carcinoma ≤3 cm: Results of an Italian multicenter study on 588 patients

Felice Giuliante, Francesco Ardito, Antonio D. Pinna, Gerardo Sarno, Stefano M. Giulini, Giorgio Ercolani, Nazario Portolani, Guido Torzilli, Matteo Donadon, Luca Aldrighetti, Carlo Pulitanò, Alfredo Guglielmi, Andrea Ruzzenente, Lorenzo Capussotti, Alessandro Ferrero, Fulvio Calise, Vincenzo Scuderi, Bruno Federico, Gennaro Nuzzo

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: The best treatment for patients with small hepatocellular carcinoma (S-HCC) is still controversial. The aim of this study was to evaluate operative and long-term results after liver resection (LR) for S-HCC, defined as tumor ≤3 cm. Study Design: Retrospective multicenter study of 588 LRs for S-HCC from 8 Italian hepatobiliary surgery units (years 1992 to 2008). Primary outcomes included operative risk. Logistic regression analysis was used to evaluate risk factors for postoperative mortality. Secondary outcomes were overall survival (OS) and disease-free survival (DFS), estimated by the Kaplan-Meier method. Results: Postoperative mortality was 1.9%, morbidity was 35.7% (major morbidity 7.3%), and blood transfusion rate was 13.8%. Child-Pugh class B and blood transfusions were associated with higher postoperative mortality. Rates of microvascular invasion and microsatellite nodules were 37.0% and 23.1%. After a median follow-up of 38.4 months, 5- and 10-year OS rates were 52.8% and 20.3%, with DFS of 32.4% and 21.7%. Local recurrence rate was 1.4%. Between the years 2000 and 2008, 5-year OS was significantly higher than that between the years 1992 and 1999 (61.9% vs 42.6%; p <0.001). In multivariable analysis, Child-Pugh class B, portal hypertension, and microsatellite lesions were independently associated with poor OS. Microsatellite lesion was the only variable independently associated with poor DFS. Conclusions: Liver resection for S-HCC has improved over the years, with decreased operative risk. Long-term survival after LR has increased. Despite small tumor size, rates of microsatellite nodules and microvascular invasion are not negligible. Presence of microsatellite lesions was the only variable identified as being associated with poor both OS and DFS.

Original languageEnglish
Pages (from-to)244-254
Number of pages11
JournalJournal of the American College of Surgeons
Volume215
Issue number2
DOIs
Publication statusPublished - Aug 2012

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Microsatellite Repeats
Multicenter Studies
Hepatocellular Carcinoma
Disease-Free Survival
Liver
Blood Transfusion
Survival
Mortality
Morbidity
Portal Hypertension
Neoplasms
Survival Rate
Retrospective Studies
Logistic Models
Regression Analysis
Recurrence
Therapeutics

Keywords

  • DFS
  • disease-free survival
  • HCC
  • hepatocellular carcinoma
  • liver resection
  • LR
  • microvascular invasion
  • mVI
  • OS
  • overall survival
  • S-HCC
  • small hepatocellular carcinoma

ASJC Scopus subject areas

  • Surgery

Cite this

Liver resection for hepatocellular carcinoma ≤3 cm : Results of an Italian multicenter study on 588 patients. / Giuliante, Felice; Ardito, Francesco; Pinna, Antonio D.; Sarno, Gerardo; Giulini, Stefano M.; Ercolani, Giorgio; Portolani, Nazario; Torzilli, Guido; Donadon, Matteo; Aldrighetti, Luca; Pulitanò, Carlo; Guglielmi, Alfredo; Ruzzenente, Andrea; Capussotti, Lorenzo; Ferrero, Alessandro; Calise, Fulvio; Scuderi, Vincenzo; Federico, Bruno; Nuzzo, Gennaro.

In: Journal of the American College of Surgeons, Vol. 215, No. 2, 08.2012, p. 244-254.

Research output: Contribution to journalArticle

Giuliante, F, Ardito, F, Pinna, AD, Sarno, G, Giulini, SM, Ercolani, G, Portolani, N, Torzilli, G, Donadon, M, Aldrighetti, L, Pulitanò, C, Guglielmi, A, Ruzzenente, A, Capussotti, L, Ferrero, A, Calise, F, Scuderi, V, Federico, B & Nuzzo, G 2012, 'Liver resection for hepatocellular carcinoma ≤3 cm: Results of an Italian multicenter study on 588 patients', Journal of the American College of Surgeons, vol. 215, no. 2, pp. 244-254. https://doi.org/10.1016/j.jamcollsurg.2012.04.013
Giuliante, Felice ; Ardito, Francesco ; Pinna, Antonio D. ; Sarno, Gerardo ; Giulini, Stefano M. ; Ercolani, Giorgio ; Portolani, Nazario ; Torzilli, Guido ; Donadon, Matteo ; Aldrighetti, Luca ; Pulitanò, Carlo ; Guglielmi, Alfredo ; Ruzzenente, Andrea ; Capussotti, Lorenzo ; Ferrero, Alessandro ; Calise, Fulvio ; Scuderi, Vincenzo ; Federico, Bruno ; Nuzzo, Gennaro. / Liver resection for hepatocellular carcinoma ≤3 cm : Results of an Italian multicenter study on 588 patients. In: Journal of the American College of Surgeons. 2012 ; Vol. 215, No. 2. pp. 244-254.
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abstract = "Background: The best treatment for patients with small hepatocellular carcinoma (S-HCC) is still controversial. The aim of this study was to evaluate operative and long-term results after liver resection (LR) for S-HCC, defined as tumor ≤3 cm. Study Design: Retrospective multicenter study of 588 LRs for S-HCC from 8 Italian hepatobiliary surgery units (years 1992 to 2008). Primary outcomes included operative risk. Logistic regression analysis was used to evaluate risk factors for postoperative mortality. Secondary outcomes were overall survival (OS) and disease-free survival (DFS), estimated by the Kaplan-Meier method. Results: Postoperative mortality was 1.9{\%}, morbidity was 35.7{\%} (major morbidity 7.3{\%}), and blood transfusion rate was 13.8{\%}. Child-Pugh class B and blood transfusions were associated with higher postoperative mortality. Rates of microvascular invasion and microsatellite nodules were 37.0{\%} and 23.1{\%}. After a median follow-up of 38.4 months, 5- and 10-year OS rates were 52.8{\%} and 20.3{\%}, with DFS of 32.4{\%} and 21.7{\%}. Local recurrence rate was 1.4{\%}. Between the years 2000 and 2008, 5-year OS was significantly higher than that between the years 1992 and 1999 (61.9{\%} vs 42.6{\%}; p <0.001). In multivariable analysis, Child-Pugh class B, portal hypertension, and microsatellite lesions were independently associated with poor OS. Microsatellite lesion was the only variable independently associated with poor DFS. Conclusions: Liver resection for S-HCC has improved over the years, with decreased operative risk. Long-term survival after LR has increased. Despite small tumor size, rates of microsatellite nodules and microvascular invasion are not negligible. Presence of microsatellite lesions was the only variable identified as being associated with poor both OS and DFS.",
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author = "Felice Giuliante and Francesco Ardito and Pinna, {Antonio D.} and Gerardo Sarno and Giulini, {Stefano M.} and Giorgio Ercolani and Nazario Portolani and Guido Torzilli and Matteo Donadon and Luca Aldrighetti and Carlo Pulitan{\`o} and Alfredo Guglielmi and Andrea Ruzzenente and Lorenzo Capussotti and Alessandro Ferrero and Fulvio Calise and Vincenzo Scuderi and Bruno Federico and Gennaro Nuzzo",
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T1 - Liver resection for hepatocellular carcinoma ≤3 cm

T2 - Results of an Italian multicenter study on 588 patients

AU - Giuliante, Felice

AU - Ardito, Francesco

AU - Pinna, Antonio D.

AU - Sarno, Gerardo

AU - Giulini, Stefano M.

AU - Ercolani, Giorgio

AU - Portolani, Nazario

AU - Torzilli, Guido

AU - Donadon, Matteo

AU - Aldrighetti, Luca

AU - Pulitanò, Carlo

AU - Guglielmi, Alfredo

AU - Ruzzenente, Andrea

AU - Capussotti, Lorenzo

AU - Ferrero, Alessandro

AU - Calise, Fulvio

AU - Scuderi, Vincenzo

AU - Federico, Bruno

AU - Nuzzo, Gennaro

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N2 - Background: The best treatment for patients with small hepatocellular carcinoma (S-HCC) is still controversial. The aim of this study was to evaluate operative and long-term results after liver resection (LR) for S-HCC, defined as tumor ≤3 cm. Study Design: Retrospective multicenter study of 588 LRs for S-HCC from 8 Italian hepatobiliary surgery units (years 1992 to 2008). Primary outcomes included operative risk. Logistic regression analysis was used to evaluate risk factors for postoperative mortality. Secondary outcomes were overall survival (OS) and disease-free survival (DFS), estimated by the Kaplan-Meier method. Results: Postoperative mortality was 1.9%, morbidity was 35.7% (major morbidity 7.3%), and blood transfusion rate was 13.8%. Child-Pugh class B and blood transfusions were associated with higher postoperative mortality. Rates of microvascular invasion and microsatellite nodules were 37.0% and 23.1%. After a median follow-up of 38.4 months, 5- and 10-year OS rates were 52.8% and 20.3%, with DFS of 32.4% and 21.7%. Local recurrence rate was 1.4%. Between the years 2000 and 2008, 5-year OS was significantly higher than that between the years 1992 and 1999 (61.9% vs 42.6%; p <0.001). In multivariable analysis, Child-Pugh class B, portal hypertension, and microsatellite lesions were independently associated with poor OS. Microsatellite lesion was the only variable independently associated with poor DFS. Conclusions: Liver resection for S-HCC has improved over the years, with decreased operative risk. Long-term survival after LR has increased. Despite small tumor size, rates of microsatellite nodules and microvascular invasion are not negligible. Presence of microsatellite lesions was the only variable identified as being associated with poor both OS and DFS.

AB - Background: The best treatment for patients with small hepatocellular carcinoma (S-HCC) is still controversial. The aim of this study was to evaluate operative and long-term results after liver resection (LR) for S-HCC, defined as tumor ≤3 cm. Study Design: Retrospective multicenter study of 588 LRs for S-HCC from 8 Italian hepatobiliary surgery units (years 1992 to 2008). Primary outcomes included operative risk. Logistic regression analysis was used to evaluate risk factors for postoperative mortality. Secondary outcomes were overall survival (OS) and disease-free survival (DFS), estimated by the Kaplan-Meier method. Results: Postoperative mortality was 1.9%, morbidity was 35.7% (major morbidity 7.3%), and blood transfusion rate was 13.8%. Child-Pugh class B and blood transfusions were associated with higher postoperative mortality. Rates of microvascular invasion and microsatellite nodules were 37.0% and 23.1%. After a median follow-up of 38.4 months, 5- and 10-year OS rates were 52.8% and 20.3%, with DFS of 32.4% and 21.7%. Local recurrence rate was 1.4%. Between the years 2000 and 2008, 5-year OS was significantly higher than that between the years 1992 and 1999 (61.9% vs 42.6%; p <0.001). In multivariable analysis, Child-Pugh class B, portal hypertension, and microsatellite lesions were independently associated with poor OS. Microsatellite lesion was the only variable independently associated with poor DFS. Conclusions: Liver resection for S-HCC has improved over the years, with decreased operative risk. Long-term survival after LR has increased. Despite small tumor size, rates of microsatellite nodules and microvascular invasion are not negligible. Presence of microsatellite lesions was the only variable identified as being associated with poor both OS and DFS.

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KW - disease-free survival

KW - HCC

KW - hepatocellular carcinoma

KW - liver resection

KW - LR

KW - microvascular invasion

KW - mVI

KW - OS

KW - overall survival

KW - S-HCC

KW - small hepatocellular carcinoma

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