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Article: Improved long-term survival after major resection for hepatocellular carcinoma: a multicenter analysis based on a new definition of major hepatectomy

TitleImproved long-term survival after major resection for hepatocellular carcinoma: a multicenter analysis based on a new definition of major hepatectomy
Authors
KeywordsHepatocellular carcinoma
Major hepatectomy
Multicenter study
Long-term survival
Issue Date2012
PublisherSpringer New York LLC.
Citation
Journal of Gastrointestinal Surgery, 2012 [Epub ahead of print] How to Cite?
AbstractBACKGROUND: Advances in the surgical management of hepatocellular carcinoma (HCC) have expanded the indications for curative hepatectomy, including more extensive liver resections. The purpose of this study was to examine long-term survival trends for patients treated with major hepatectomy for HCC. PATIENTS AND METHODS: Clinicopathologic data for 1,115 patients with HCC who underwent hepatectomy between 1981 and 2008 at five hepatobiliary centers in France, China, and the USA were assessed. In addition to other performance metrics, outcomes were evaluated using resection of >/=4 liver segments as a novel definition of major hepatectomy. RESULTS: Major hepatectomy was performed in 539 patients. In the major hepatectomy group, median tumor size was 10 cm (range: 1-27 cm) and 22 % of the patients had bilateral lesions. The TNM Stage distribution included 29 % Stage I, 31 % Stage II, 38 % Stage III, and 2 % Stage IV. The postoperative histologic examination indicated that chronic liver disease was present in 35 % of the patients and tumor microvascular invasion was identified in 60 % of the patients. The 90-day postoperative mortality rate was 4 %. After a median follow-up time of 63 months, the 5-year overall survival rate was 40 %. Patients treated with right hepatectomy (n = 332) and those requiring extended hepatectomy (n = 207) had similar 90-day postoperative mortality rates (4 % and 4 %, respectively, p = 0.976) and 5-year overall survival rates (42 % and 36 %, respectively, p = 0.523). Postoperative mortality and overall survival rates after major hepatectomy were similar among the participating countries (p > 0.1) and improved over time with 5-year survival rates of 30 %, 40 %, and 51 % for the years 1981-1989, 1990-1999, and the most recent era of 2000-2008, respectively (p = 0.004). In multivariate analysis, factors that were significantly associated with worse survivals included AFP level >1,000 ng/mL, tumor size >5 cm, presence of major vascular invasion, presence of extrahepatic metastases, positive surgical margins, and earlier time period in which the major hepatectomy was performed. CONCLUSIONS: This multinational, long-term HCC survival analysis indicates that expansion of surgical indications to include major hepatectomy is justified by the significant improvement in outcomes over the past three decades observed in both the East and the West.
Persistent Identifierhttp://hdl.handle.net/10722/169270
ISSN
2015 Impact Factor: 2.807
2015 SCImago Journal Rankings: 1.640
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorAndreou, Aen_US
dc.contributor.authorVauthey, JNen_US
dc.contributor.authorCherqui, Den_US
dc.contributor.authorZimmitti, Gen_US
dc.contributor.authorRibero, D-
dc.contributor.authorTruty, MJ-
dc.contributor.authorWei, SH-
dc.contributor.authorCurley, SA-
dc.contributor.authorLaurent, A-
dc.contributor.authorPoon, RT-
dc.contributor.authorBelghiti, J-
dc.contributor.authorNagorney, DM-
dc.contributor.authorAloia, TA-
dc.contributor.authorInternational Cooperative Study Group on Hepatocellular Carcinoma-
dc.date.accessioned2012-10-18T08:48:12Z-
dc.date.available2012-10-18T08:48:12Z-
dc.date.issued2012en_US
dc.identifier.citationJournal of Gastrointestinal Surgery, 2012 [Epub ahead of print]en_US
dc.identifier.issn1091-255X-
dc.identifier.urihttp://hdl.handle.net/10722/169270-
dc.description.abstractBACKGROUND: Advances in the surgical management of hepatocellular carcinoma (HCC) have expanded the indications for curative hepatectomy, including more extensive liver resections. The purpose of this study was to examine long-term survival trends for patients treated with major hepatectomy for HCC. PATIENTS AND METHODS: Clinicopathologic data for 1,115 patients with HCC who underwent hepatectomy between 1981 and 2008 at five hepatobiliary centers in France, China, and the USA were assessed. In addition to other performance metrics, outcomes were evaluated using resection of >/=4 liver segments as a novel definition of major hepatectomy. RESULTS: Major hepatectomy was performed in 539 patients. In the major hepatectomy group, median tumor size was 10 cm (range: 1-27 cm) and 22 % of the patients had bilateral lesions. The TNM Stage distribution included 29 % Stage I, 31 % Stage II, 38 % Stage III, and 2 % Stage IV. The postoperative histologic examination indicated that chronic liver disease was present in 35 % of the patients and tumor microvascular invasion was identified in 60 % of the patients. The 90-day postoperative mortality rate was 4 %. After a median follow-up time of 63 months, the 5-year overall survival rate was 40 %. Patients treated with right hepatectomy (n = 332) and those requiring extended hepatectomy (n = 207) had similar 90-day postoperative mortality rates (4 % and 4 %, respectively, p = 0.976) and 5-year overall survival rates (42 % and 36 %, respectively, p = 0.523). Postoperative mortality and overall survival rates after major hepatectomy were similar among the participating countries (p > 0.1) and improved over time with 5-year survival rates of 30 %, 40 %, and 51 % for the years 1981-1989, 1990-1999, and the most recent era of 2000-2008, respectively (p = 0.004). In multivariate analysis, factors that were significantly associated with worse survivals included AFP level >1,000 ng/mL, tumor size >5 cm, presence of major vascular invasion, presence of extrahepatic metastases, positive surgical margins, and earlier time period in which the major hepatectomy was performed. CONCLUSIONS: This multinational, long-term HCC survival analysis indicates that expansion of surgical indications to include major hepatectomy is justified by the significant improvement in outcomes over the past three decades observed in both the East and the West.-
dc.languageengen_US
dc.publisherSpringer New York LLC.-
dc.relation.ispartofJournal of Gastrointestinal Surgeryen_US
dc.rightsThe original publication is available at www.springerlink.com-
dc.subjectHepatocellular carcinoma-
dc.subjectMajor hepatectomy-
dc.subjectMulticenter study-
dc.subjectLong-term survival-
dc.titleImproved long-term survival after major resection for hepatocellular carcinoma: a multicenter analysis based on a new definition of major hepatectomyen_US
dc.typeArticleen_US
dc.identifier.emailPoon, RT: poontp@hku.hken_US
dc.identifier.authorityPoon, RTP=rp00446en_US
dc.identifier.doi10.1007/s11605-012-2005-4-
dc.identifier.pmid22948836-
dc.identifier.scopuseid_2-s2.0-84871971732-
dc.identifier.hkuros211513en_US
dc.identifier.isiWOS:000313074300021-
dc.publisher.placeUnited States-
dc.identifier.citeulike11237552-

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