Impact of extent of surgical resection on the outcomes of hepatocellular carcinoma based on prognostic factors

Abstract

BACKGROUND: Tumour stage and microvascular invasion are frontline predictors of HCC recurrence. If these factors are controlled, impact of resection extent may be highlighted. This study evaluated the impact of resection extent on the outcome of hepatocellular carcinoma (HCC). METHOD: Totally 777 patients who underwent curative resection for HCC were divided into the minor and major resection groups and their survival was compared. Further, patients were divided as with good prognostic factor (early-stage tumours, n=365), no microvascular invasion (n=435), poor prognostic factor (advanced-stage tumours, n=412), and microvascular invasion (n=342). In 82 patients with excellent prognosis (early-stage tumour, tumour < 5cm, no microvascular invasion, well-differentiated HCC), survival was compared according to the specimen weight. RESULTS: Early-stage tumours correlated with better recurrence-free survival after major resection (minor 45 months vs. major 90 months, p=0.001), but not advanced-stage tumours (minor 8 months vs. major 7.6 months, p=0.526). But overall survival was not affected. A similar pattern was noted cases with and without microvascular invasion. In best prognostic tumours, specimen weight was the most important predictor of recurrence (OR=3.86, p=0.011). Totally 292 patients developed intrahepatic recurrence. A greater proportion of patients with minor resection underwent curative treatment (re-resection: 20% vs. 13.5%, ablation: 24% vs. 17%) for recurrence. Minor resection for primary tumour seemed to prolong overall survival (minor 104 months vs. major 87 months, p=0.062) when recurrence developed. CONCLUSION: With good prognostic tumours, major resection reduces recurrence rate. Poor prognostic tumours benefit from minor resection as it preserves hepatic parenchyma for future treatment of recurrence.