TY - JOUR
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
PY - 2012/8
Y1 - 2012/8
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.
KW - DFS
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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U2 - 10.1016/j.jamcollsurg.2012.04.013
DO - 10.1016/j.jamcollsurg.2012.04.013
M3 - Article
C2 - 22634119
AN - SCOPUS:84864277031
VL - 215
SP - 244
EP - 254
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
SN - 1072-7515
IS - 2
ER -