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Article: Treatment strategy to improve long-term survival for hepatocellular carcinoma smaller than 5 cm: Major hepatectomy vs minor hepatectomy

TitleTreatment strategy to improve long-term survival for hepatocellular carcinoma smaller than 5 cm: Major hepatectomy vs minor hepatectomy
Authors
Issue Date2014
Citation
World Journal of Surgery, 2014, v. 38, n. 9, p. 2386-2394 How to Cite?
AbstractBackground: The extent of hepatectomy for solitary hepatocellular carcinoma (HCC) <5 cm is controversial. Methods: This is a retrospective review of patients with solitary HCC <5 cm, who underwent liver resection in a tertiary referral centre in Hong Kong between January 1989 and December 2009. Baseline demographics, liver function, peri-operative outcomes, and overall survival were compared. Results: A total of 348 cirrhotic patients with a solitary HCC <5 cm underwent either major hepatectomy (n = 93) or minor hepatectomy (n = 255). Child-Pugh status did not differ, 98.9 vs. 96.1 % (p = 0.319); all patients who underwent major and minor hepatectomy were classified as Child-Pugh status A. Patients who underwent major hepatectomy had a larger median tumor size (4.0 vs. 2.5 cm, p < 0.001) and they also had more advanced stage of disease (stage I/II/IIIa: 10.8/55.9/33.3 vs. 26.7/52.9/20.4 %, p = 0.002). Median operative time for major hepatectomy was significantly longer (415 vs. 248 min, p < 0.001) and entailed greater blood loss (0.9 vs. 0.5 l, p < 0.001). Despite larger tumor size and more advanced stage of disease in the major hepatectomy group, hospital mortality (5.4 vs. 2.0 %, p = 0.185), complication rates (30.1 vs. 23.1 %, p = 0.234), and transfusion rate (10.8 vs. 11.4 %, p = 0.862) were the same between the two groups. Overall survival was significantly better for those who underwent major hepatectomy, with a median survival of 147.5 vs. 92.1 months (p = 0.043), and they had a better 5- and 10-year disease-free survival rate (57.3 vs. 40.2, 38.1 vs. 18.9 %, p = 0.003). In subgroup analysis, the 10-year survival for patients with stage II HCC and tumor <5 cm was 68.6 vs. 36.6 % in those who received minor hepatectomy alone (p = 0.027). Conclusions: Major hepatectomy provided better long-term survival benefit in patients with HCC <5 cm, particularly in those with stage II disease. © 2014 Société Internationale de Chirurgie.
Persistent Identifierhttp://hdl.handle.net/10722/221371
ISSN
2015 Impact Factor: 2.523
2015 SCImago Journal Rankings: 1.375
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWong, TCL-
dc.contributor.authorCheung, TT-
dc.contributor.authorChok, KSH-
dc.contributor.authorChan, ACY-
dc.contributor.authorDai, WC-
dc.contributor.authorChan, SC-
dc.contributor.authorPoon, RTP-
dc.contributor.authorLo, CM-
dc.date.accessioned2015-11-18T06:09:08Z-
dc.date.available2015-11-18T06:09:08Z-
dc.date.issued2014-
dc.identifier.citationWorld Journal of Surgery, 2014, v. 38, n. 9, p. 2386-2394-
dc.identifier.issn0364-2313-
dc.identifier.urihttp://hdl.handle.net/10722/221371-
dc.description.abstractBackground: The extent of hepatectomy for solitary hepatocellular carcinoma (HCC) <5 cm is controversial. Methods: This is a retrospective review of patients with solitary HCC <5 cm, who underwent liver resection in a tertiary referral centre in Hong Kong between January 1989 and December 2009. Baseline demographics, liver function, peri-operative outcomes, and overall survival were compared. Results: A total of 348 cirrhotic patients with a solitary HCC <5 cm underwent either major hepatectomy (n = 93) or minor hepatectomy (n = 255). Child-Pugh status did not differ, 98.9 vs. 96.1 % (p = 0.319); all patients who underwent major and minor hepatectomy were classified as Child-Pugh status A. Patients who underwent major hepatectomy had a larger median tumor size (4.0 vs. 2.5 cm, p < 0.001) and they also had more advanced stage of disease (stage I/II/IIIa: 10.8/55.9/33.3 vs. 26.7/52.9/20.4 %, p = 0.002). Median operative time for major hepatectomy was significantly longer (415 vs. 248 min, p < 0.001) and entailed greater blood loss (0.9 vs. 0.5 l, p < 0.001). Despite larger tumor size and more advanced stage of disease in the major hepatectomy group, hospital mortality (5.4 vs. 2.0 %, p = 0.185), complication rates (30.1 vs. 23.1 %, p = 0.234), and transfusion rate (10.8 vs. 11.4 %, p = 0.862) were the same between the two groups. Overall survival was significantly better for those who underwent major hepatectomy, with a median survival of 147.5 vs. 92.1 months (p = 0.043), and they had a better 5- and 10-year disease-free survival rate (57.3 vs. 40.2, 38.1 vs. 18.9 %, p = 0.003). In subgroup analysis, the 10-year survival for patients with stage II HCC and tumor <5 cm was 68.6 vs. 36.6 % in those who received minor hepatectomy alone (p = 0.027). Conclusions: Major hepatectomy provided better long-term survival benefit in patients with HCC <5 cm, particularly in those with stage II disease. © 2014 Société Internationale de Chirurgie.-
dc.languageeng-
dc.relation.ispartofWorld Journal of Surgery-
dc.titleTreatment strategy to improve long-term survival for hepatocellular carcinoma smaller than 5 cm: Major hepatectomy vs minor hepatectomy-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s00268-014-2601-4-
dc.identifier.pmid24831671-
dc.identifier.scopuseid_2-s2.0-84905678614-
dc.identifier.hkuros233271-
dc.identifier.volume38-
dc.identifier.issue9-
dc.identifier.spage2386-
dc.identifier.epage2394-
dc.identifier.eissn1432-2323-
dc.identifier.isiWOS:000340421700029-

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