Recurrence determined 10-year survival of hepatocellular carcinoma after hepatectomy

Abstract

INTRODUCTION: The reported actual 10-year survival rate of hepatocellular carcinoma (HCC) after hepatectomy was 7.2% only. Our study was conducted to compare the characteristics of HCC patients who survived >10 years after hepatectomy. METHOD: This was a retrospective study in a university affiliated hospital. All patients who had hepatectomy for HCC from 1990 to 2004 were analyzed. Data was retrieved from a prospective collected database. Baseline, operative, pathological and survival data between 10-year survivors were compared to non 10-year survivors. RESULTS: There were 727 HCC patients who had hepatectomy and 247 (34.0%) patients survived _10 years after hepatectomy. Among these 10 year survivors, 150 (60.6%) patients were disease free. 10-year survivors were younger (52 vs. 55 year old, p = 0.04), more likely to have screen detected HCC (54.3 vs. 33.5%, p < 0.001) and had better liver function (indocyanine green retention at 15 mins: 9 vs. 10.9%, p = 0.003). The use of major hepatectomy (61.1 vs. 62.1%, p = 0.80), anterior approach (20.6 vs. 20.8%, p = 0.95) and Pringle manoeuver (32.4 vs. 33.8%, p = 0.71) were not different. There was no difference in postoperative complication and hospital mortality. Non 10-year survivors were more likely to have tumors with marco- or microscopic vascular invasion, microsatellite nodule and multiple tumors (>3). In multivariable analysis, tumor recurrence was associated with inferior survival. CONCLUSION: We have demonstrated 34% of HCC patients can survive at least 10-years after hepatectomy. Timing and pattern of tumor recurrence predicted long-term survivals. characteristics and complications were recorded. Follow up imaging was reviewed to determine rates of complete ablation, local, regional and metastatic recurrence. Results: Two hundred nineteen patients were included with a total of 340 tumors treated with operative MWA. Median tumor size was 3.2cm (1e6 cm). Cirrhosis was present in 89.5% of patients, 60.7% had hepatitis C, and 8.2% had hepatitis B. 25.9% were Child Pugh class B/C. 96.8% of MWA procedures were performed laparoscopically. Four deaths occurred within 30 days (1.8%). Clavien-Dindo grade III complications occurred in 3.2% of patients. Complete ablation was identified in 97.1% of tumors, with local recurrence rates of 8.5% at 10.9 months median follow up (0e80 months). Regional recurrence occurred in 34.8% of patients at 10.9 months median follow up and metastatic recurrence was seen in 8.1% of patients. One year overall survival was 80.0% and two year survival was 61.5%. Conclusions: We propose that laparoscopic MWA offers a low morbidity approach for treatment of HCC affording low rates of local recurrence even for patients with significant underlying liver dysfunction. This large series offers insight into outcomes of this modality as definitive treatment for patients with HCC.