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Conference Paper: Comparable surgical outcomes after downstaging of unresectable hepatocellular carcinoma - a propensity score analysis

TitleComparable surgical outcomes after downstaging of unresectable hepatocellular carcinoma - a propensity score analysis
Authors
Issue Date2016
PublisherElsevier Ltd. The Journal's web site is located at http://www.hpbonline.org/
Citation
The 12th World Congress of the International Hepato-Pancreato-Biliary Association (IHPBA 2016), São Paulo, Brazil, 20-23 April 2016. In HPB, 2016, v. 18 suppl. 1, p. e138, abstract no. TP09-2 How to Cite?
AbstractINTRODUCTION: This study aims to explore whether hepatectomy after downstaging of unresectable hepatocellular carcinoma (HCC) provides similar long-term survival to upfront surgery. METHOD: This was a retrospective study from a university hospital from 1991–2014. Data was retrieved from a prospectively collected database. All HCC patients who had unresectable, nontransplantable and nonablatable tumors received palliative treatment. Hepatectomy was offered if tumors became resectable after downstage therapy. Outcomes of them were compared to patients who had upfront hepatectomy; matching was performed using propensity score analysis in 1:6 ratio using criteria: Child grade, 7th UICC staging and lymphovascular permeation. RESULTS: 44 patients had hepatectomy after downstage therapy (Transarterial chemoembolization alone in 37, sorafenib alone = 2, selective internal radiation therapy alone = 1, combination = 4). Median time from downstage treatment to surgery was 10 (3–61) months. Baseline characteristics were comparable including age, sex, hepatitis B infection, comorbid disease and Child grade. Operative outcomes were also similar; major hepatectomy (54.9 vs. 50% in upfront and downstage group respectively, p = 0.54), blood loss (0.96 vs. 1L, p = 0.76) and operative time (406 vs. 436 mins, p = 0.34). Pathological characteristics including tumor size, number, differentiation, cirrhosis and lymphovascular permeation didn't differ but downstaged patients were more likely to have bilobar disease (17.4 vs. 36.4%, p = 0.004). Overall complication (26.5 vs. 40.9%, p = 0.05) and hospital mortality (1.5 vs. 0%, p = 0.92) were comparable. Overall and disease free survivals were similar. CONCLUSION: Outcomes and survivals in downstage group were comparable to those who had upfront hepatectomy. Regular evaluation for treatment response and resectability is warranted.
Persistent Identifierhttp://hdl.handle.net/10722/236483
ISSN
2015 Impact Factor: 2.918
2015 SCImago Journal Rankings: 1.586

 

DC FieldValueLanguage
dc.contributor.authorWong, CLT-
dc.contributor.authorCheung, TT-
dc.contributor.authorChok, KSH-
dc.contributor.authorChan, ACY-
dc.contributor.authorDai, WC-
dc.contributor.authorChan, SC-
dc.contributor.authorLo, CM-
dc.date.accessioned2016-11-25T00:54:03Z-
dc.date.available2016-11-25T00:54:03Z-
dc.date.issued2016-
dc.identifier.citationThe 12th World Congress of the International Hepato-Pancreato-Biliary Association (IHPBA 2016), São Paulo, Brazil, 20-23 April 2016. In HPB, 2016, v. 18 suppl. 1, p. e138, abstract no. TP09-2-
dc.identifier.issn1365-182X-
dc.identifier.urihttp://hdl.handle.net/10722/236483-
dc.description.abstractINTRODUCTION: This study aims to explore whether hepatectomy after downstaging of unresectable hepatocellular carcinoma (HCC) provides similar long-term survival to upfront surgery. METHOD: This was a retrospective study from a university hospital from 1991–2014. Data was retrieved from a prospectively collected database. All HCC patients who had unresectable, nontransplantable and nonablatable tumors received palliative treatment. Hepatectomy was offered if tumors became resectable after downstage therapy. Outcomes of them were compared to patients who had upfront hepatectomy; matching was performed using propensity score analysis in 1:6 ratio using criteria: Child grade, 7th UICC staging and lymphovascular permeation. RESULTS: 44 patients had hepatectomy after downstage therapy (Transarterial chemoembolization alone in 37, sorafenib alone = 2, selective internal radiation therapy alone = 1, combination = 4). Median time from downstage treatment to surgery was 10 (3–61) months. Baseline characteristics were comparable including age, sex, hepatitis B infection, comorbid disease and Child grade. Operative outcomes were also similar; major hepatectomy (54.9 vs. 50% in upfront and downstage group respectively, p = 0.54), blood loss (0.96 vs. 1L, p = 0.76) and operative time (406 vs. 436 mins, p = 0.34). Pathological characteristics including tumor size, number, differentiation, cirrhosis and lymphovascular permeation didn't differ but downstaged patients were more likely to have bilobar disease (17.4 vs. 36.4%, p = 0.004). Overall complication (26.5 vs. 40.9%, p = 0.05) and hospital mortality (1.5 vs. 0%, p = 0.92) were comparable. Overall and disease free survivals were similar. CONCLUSION: Outcomes and survivals in downstage group were comparable to those who had upfront hepatectomy. Regular evaluation for treatment response and resectability is warranted.-
dc.languageeng-
dc.publisherElsevier Ltd. The Journal's web site is located at http://www.hpbonline.org/-
dc.relation.ispartofHPB-
dc.rightsPosting accepted manuscript (postprint): © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/-
dc.titleComparable surgical outcomes after downstaging of unresectable hepatocellular carcinoma - a propensity score analysis-
dc.typeConference_Paper-
dc.identifier.emailWong, CLT: wongtcl@hku.hk-
dc.identifier.emailCheung, TT: cheung68@hku.hk-
dc.identifier.emailChok, KSH: chok6275@hku.hk-
dc.identifier.emailChan, ACY: acchan@hku.hk-
dc.identifier.emailDai, WC: daiwc@hku.hk-
dc.identifier.emailChan, SC: chanlsc@hkucc.hku.hk-
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hk-
dc.identifier.authorityWong, CLT=rp01679-
dc.identifier.authorityCheung, TT=rp02129-
dc.identifier.authorityChok, KSH=rp02110-
dc.identifier.authorityChan, ACY=rp00310-
dc.identifier.authorityChan, SC=rp01568-
dc.identifier.authorityLo, CM=rp00412-
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1016/j.hpb.2016.02.326-
dc.identifier.hkuros270407-
dc.identifier.volume18-
dc.identifier.issuesuppl. 1-
dc.identifier.spagee138, abstract no. TP09-2-
dc.identifier.epagee138, abstract no. TP09-2-
dc.publisher.placeUnited Kingdom-

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