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Article: Hepatic resection for bilobar hepatocellular carcinoma: Is it justified?

TitleHepatic resection for bilobar hepatocellular carcinoma: Is it justified?
Authors
Issue Date2003
PublisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.com
Citation
Archives Of Surgery, 2003, v. 138 n. 1, p. 100-104 How to Cite?
AbstractHypothesis: Patients with bilobar stage IVa hepatocellular carcinoma (HCC) are generally considered unsuitable for hepatic resection. Recent data suggest that palliative hepatic resection in selected patients with advanced HCC may result in a favorable survival outcome. The aim of the present study was to evaluate the operative outcome and survival benefits of hepatic resection for patients with bilobar HCC. Design: Retrospective study. Setting: Tertiary referral center. Patients: The study comprised 78 patients who were diagnosed as having unilobar HCC and considered initially suitable candidates for curative hepatic resection on preoperative investigations from 1989 to 2000. Bilobar disease with discrete tumor nodules in the contralateral lobe was diagnosed in these patients on laparoscopy (44 patients) or laparotomy (34 patients) with the help of intraoperative ultrasonography. Fifteen patients (19%) underwent palliative hepatic resection (group A), and hepatic resection was not performed in the remaining 63 patients (81%) (group B). Main Outcome Measures: The clinicopathologic data and operative and survival outcomes of both groups of patients were compared. Results: The clinicopathologic parameters were comparable in both groups of patients. In group A, 12 patients (80%) underwent major hepatic resection, and the mean ± SEM size of the resected tumors was 8.3 ± 0.9 cm. The operative morbidity and mortality were 20% and 0%, respectively. Treatment for tumors in the contralateral lobe included wedge excision (5 patients), alcohol injection (5 patients), cryotherapy (2 patients), and transarterial oily chemoembolization (3 patients). In group B, treatment for HCC included transarterial oily chemoembolization (42 patients), systemic chemotherapy (3 patients), transarterial oily chemoembolization and systemic chemotherapy (5 patients), cryotherapy (2 patients), tamoxifen (3 patients), and no treatment (8 patients). The median survival of patients in group A was 19.5 months, with 4 patients surviving for more than 3 years. The survival in group A was significantly better than in group B (median= 7.1 months; P=.008). On multivariate analysis, hepatic resection and preoperative serum α-fetoprotein level were the 2 independent factors that significantly affected patient survival. Conclusions: Hepatic resection for HCC in patients with stage IVa bilobar disease results in a better survival outcome than nonresectional therapies. It should be considered in selected patients with low operative risks and satisfactory liver function.
Persistent Identifierhttp://hdl.handle.net/10722/88822
ISSN
2014 Impact Factor: 4.926
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLiu, CLen_HK
dc.contributor.authorFan, STen_HK
dc.contributor.authorLo, CMen_HK
dc.contributor.authorNg, IOLen_HK
dc.contributor.authorPoon, RTPen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2010-09-06T09:48:27Z-
dc.date.available2010-09-06T09:48:27Z-
dc.date.issued2003en_HK
dc.identifier.citationArchives Of Surgery, 2003, v. 138 n. 1, p. 100-104en_HK
dc.identifier.issn0004-0010en_HK
dc.identifier.urihttp://hdl.handle.net/10722/88822-
dc.description.abstractHypothesis: Patients with bilobar stage IVa hepatocellular carcinoma (HCC) are generally considered unsuitable for hepatic resection. Recent data suggest that palliative hepatic resection in selected patients with advanced HCC may result in a favorable survival outcome. The aim of the present study was to evaluate the operative outcome and survival benefits of hepatic resection for patients with bilobar HCC. Design: Retrospective study. Setting: Tertiary referral center. Patients: The study comprised 78 patients who were diagnosed as having unilobar HCC and considered initially suitable candidates for curative hepatic resection on preoperative investigations from 1989 to 2000. Bilobar disease with discrete tumor nodules in the contralateral lobe was diagnosed in these patients on laparoscopy (44 patients) or laparotomy (34 patients) with the help of intraoperative ultrasonography. Fifteen patients (19%) underwent palliative hepatic resection (group A), and hepatic resection was not performed in the remaining 63 patients (81%) (group B). Main Outcome Measures: The clinicopathologic data and operative and survival outcomes of both groups of patients were compared. Results: The clinicopathologic parameters were comparable in both groups of patients. In group A, 12 patients (80%) underwent major hepatic resection, and the mean ± SEM size of the resected tumors was 8.3 ± 0.9 cm. The operative morbidity and mortality were 20% and 0%, respectively. Treatment for tumors in the contralateral lobe included wedge excision (5 patients), alcohol injection (5 patients), cryotherapy (2 patients), and transarterial oily chemoembolization (3 patients). In group B, treatment for HCC included transarterial oily chemoembolization (42 patients), systemic chemotherapy (3 patients), transarterial oily chemoembolization and systemic chemotherapy (5 patients), cryotherapy (2 patients), tamoxifen (3 patients), and no treatment (8 patients). The median survival of patients in group A was 19.5 months, with 4 patients surviving for more than 3 years. The survival in group A was significantly better than in group B (median= 7.1 months; P=.008). On multivariate analysis, hepatic resection and preoperative serum α-fetoprotein level were the 2 independent factors that significantly affected patient survival. Conclusions: Hepatic resection for HCC in patients with stage IVa bilobar disease results in a better survival outcome than nonresectional therapies. It should be considered in selected patients with low operative risks and satisfactory liver function.en_HK
dc.languageengen_HK
dc.publisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.comen_HK
dc.relation.ispartofArchives of Surgeryen_HK
dc.subject.meshAdolescenten_HK
dc.subject.meshAdulten_HK
dc.subject.meshAgeden_HK
dc.subject.meshCarcinoma, Hepatocellular - pathology - surgeryen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHepatectomy - methodsen_HK
dc.subject.meshHumansen_HK
dc.subject.meshLaparoscopyen_HK
dc.subject.meshLiver Neoplasms - pathology - surgeryen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshNeoplasm Stagingen_HK
dc.subject.meshPalliative Care - methodsen_HK
dc.subject.meshRetrospective Studiesen_HK
dc.subject.meshSurvival Analysisen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titleHepatic resection for bilobar hepatocellular carcinoma: Is it justified?en_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0004-0010&volume=138&spage=100&epage=104&date=2003&atitle=Hepatic+resection+for+bilobar+hepatocellular+carcinoma:+is+it+justified?en_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailNg, IOL: iolng@hku.hken_HK
dc.identifier.emailPoon, RTP: poontp@hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityNg, IOL=rp00335en_HK
dc.identifier.authorityPoon, RTP=rp00446en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.pmid12511161-
dc.identifier.scopuseid_2-s2.0-0037225891en_HK
dc.identifier.hkuros77114en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0037225891&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume138en_HK
dc.identifier.issue1en_HK
dc.identifier.spage100en_HK
dc.identifier.epage104en_HK
dc.identifier.isiWOS:000180288800021-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLiu, CL=7409789712en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridNg, IOL=7102753722en_HK
dc.identifier.scopusauthoridPoon, RTP=7103097223en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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