Perioperative Factors Affecting Long-Term Outcomes of 473 Consecutive Patients Undergoing Hepatectomy for Hepatocellular Carcinoma

• Published in: Annals of surgical oncology Vol. 16; no. 7; pp. 1832 - 1842
• Main Authors: Wang, Chih-Chi, Iyer, Shridhar G., Low, Jee Keem, Lin, Chih-Yun, Wang, Shih-Ho, Lu, Sen-Nan, Chen, Chao-Long
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.07.2009; Springer Nature B.V
• Subjects: Adult; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - surgery; Carcinoma, Hepatocellular - virology; Disease-Free Survival; Female; Hepatectomy - mortality; Hepatobiliary and Pancreatic Tumors; Humans; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Liver Neoplasms - virology; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Prognosis; Surgery; Surgical Oncology; Survival Analysis; Treatment Outcome; Microvascular Invasion; Percutaneous Ethanol Injection; Liver Resection; Pringle Maneuver; Parenchymal Transection
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-009-0448-y

Background The aim of this study was to evaluate the long-term outcomes of liver resection for hepatocellular carcinoma (HCC). Methods Between January 1993 and December 2002, a total of 473 patients underwent hepatectomy for HCC at a medical center in Taiwan. Clinicopathological and surgical characteristics were studied to identify prognostic factors influencing survival. Results There were 379 men (80.1%) with mean ± standard deviation age of 53.1 ± 13.1 years. The etiology of HCC was hepatitis B ( n  = 277), hepatitis C ( n  = 90), coinfection with hepatitis B and C ( n  = 47), and non–B or C hepatitis ( n  = 50). The blood loss was 282.3 ± 370.5 ml, and 411 patients (86.9%) did not require perioperative blood transfusion. On univariate analysis, the statistically significant independent factors for disease-free survival were alfa-fetoprotein (AFP) levels of >400 ng/ml, indocyanine green retention of >10%, Pringle maneuver, blood transfusion, tumor diameter >5 cm, bilateral tumors, microvascular invasion, adjacent tissue invasion, daughter nodules and cirrhotic liver. The univariate factors influencing overall survival were similar to those influencing disease-free survival except for AFP. Independent factors that statistically significantly affected overall survival on multivariate analysis included Pringle maneuver, blood transfusion, tumor diameter >3 cm, microvascular invasion, daughter nodules, and liver cirrhosis. The 1-, 5-, and 10-year disease-free survival were 75.3, 43.3, and 22.3%, respectively. The 1-, 5-, and 10-year overall survival were 86.7, 55, and 33.7%, respectively. Conclusions AFP, indocyanine green retention of >10%, blood transfusion, Pringle maneuver, tumor diameter of >3 cm, bilateral tumors, microvascular invasion, adjacent tissue invasion, daughter nodules, and liver cirrhosis influence survival.