Archive




Volume 8, Issue 4, August 2020, Page: 123-131
Impact of Tumor Size as a Prognostic Factor After One Stage Liver Resection for Solitary Hepatocellular Carcinoma in Cirrhotic Patients
Alhassan Mohamed Hassan, Department of Surgery, Faculty of Medicine, Tanat University, Tanta, Egypt
Amir Fawzy Abdelhamid, Department of Surgery, Faculty of Medicine, Tanat University, Tanta, Egypt
Hosam Barakat Barakat, Department of Surgery, Faculty of Medicine, Tanat University, Tanta, Egypt
Soliman Mohamed Soliman, Department of Surgery, Faculty of Medicine, Tanat University, Tanta, Egypt
Hossamaldin Mohamed Soliman, Departement of Surgery, Menofeya National Liver Insistute, Menofeya University, Shebin El-kom, Egypt
Mohamed Abdalla Hablus, Department of Surgery, Faculty of Medicine, Tanat University, Tanta, Egypt
Mahmoud Mostafa Alshareef, Department of Surgery, Faculty of Medicine, Tanat University, Tanta, Egypt
Received: May 27, 2020;       Accepted: Jun. 28, 2020;       Published: Jul. 7, 2020
DOI: 10.11648/j.js.20200804.15      View  227      Downloads  88
Abstract
Aim: This study is to assess tumor size as a prognostic factor predicting outcomes after one staged hepatectomy for cirrhotic patients with solitary hepatocellular carcinoma. Patients and methods: The study included 41 patients with single hepatocellular carcinoma (HCC) of different sizes who underwent single-stage hepatectomy. Patients were divided according to their tumor size into 2 groups, group A involved patient with tumors ≤ 5 cm and group B which involved patients with tumors > 5 cm. The effect of the tumor size on overall survival and disease-free survival was studied in both groups. Results: The mean age of the studied groups was 59.60±6.89 years. Hepatitis C infection was found 82.9% of patients. Six patients (17.1%) received treatment of HCV. All patients were of Child-Pugh class A (77.1% were scores 5 and 22.9% were score 6). The median Alpha-fetoprotein (AFP) level was 240 ng/ml. The mean operative time was 186.4±52.4 min. During the follow-up period (12-24 months), 12 patients (34.3%) developed recurrence. The mean time of recurrence was 15.50±4.23 months. Cumulative disease-free survival (DFS) at the end of the study was 65.7%. The cumulative overall survival (OAS) proportion at the end of the study was 74.3%. Conclusion: Our results suggest that surgical resection for large HCC is safe and effective and that the first-line treatment for large HCC to be considered is surgical resection in selected patients. Our study showed that hepatectomy for large HCC could be performed with an acceptable morbidity and mortality rate. With the improvement in patient selection and treatment strategy, solitary large HCC is not a contraindication to surgical therapy.
Keywords
Tumor Size, Solitary HCC, Resection, Single Stage
To cite this article
Alhassan Mohamed Hassan, Amir Fawzy Abdelhamid, Hosam Barakat Barakat, Soliman Mohamed Soliman, Hossamaldin Mohamed Soliman, Mohamed Abdalla Hablus, Mahmoud Mostafa Alshareef, Impact of Tumor Size as a Prognostic Factor After One Stage Liver Resection for Solitary Hepatocellular Carcinoma in Cirrhotic Patients, Journal of Surgery. Vol. 8, No. 4, 2020, pp. 123-131. doi: 10.11648/j.js.20200804.15
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Lafaro, K. J., Deemirjian, A. N., Pawlik, T. M. (2015). Epidemiology of Hepatocellular Carcinoma. Surg Oncol Clin N Am, 24: 1-17.
[2]
Garancini, M., Pinotti, E., Nespoli, S., Romano, F. (2016). Hepatic Resection Beyond Barcelona Clinic Liver Cancer Indication: When and How. World Journal of Hepatology, 8 (11): 513-516.
[3]
Aziz, A. M., Zakaria, H., Ayuob, I., Soliman, H. E., and Othman, M. (2016). The safety and adequacy of liver resection for large hepatocellular carcinoma: A retrospective single institute study. Saudi surgical journal, 4: 20-28.
[4]
Wong, T. L., Cheung, T. T., Chok, K. S., Poon, R. T. (2014). Treatment Strategy to Improve Long Term Survival for Hepatocellular Carcinoma Smaller than 5 cm: Major Hepatectomy Vs Minor Hepatectomy. World Journal of Surgery, 38: 2386-2394.
[5]
Lim, K. C., Chow, P. K., Allen, J. C., Siddiqui, F. J. (2012). Systemic Review of Outcomes of Liver Resection for Early Hepatocellular Within Milan Criteria. British Journal of Surgery, 99 (12): 1622-1629.
[6]
Guglielmi, A., Ruzzenente, A., Conci, S., Valdegamberi, A. (2014). Hepatocellular Carcinoma: Surgical Perspectives Beyond the Barcelona Clinic Liver Cancer Recommendations. World Journal of Gastroenterology, 20: 7527-7533.
[7]
Chan, Y. C., Kabiling, C. S., Pillai, V. G., Gusatavo, A. (2015). Survial Outcomes Between Hepatic Resection and Transarterial Embolization for Hepatocellular Carcinoma More than 10 cm: A Propensity Score Model. World Journal of Surgery, 39: 1510-1518.
[8]
Lim, C., Sakamoto, Y., Yamamoto, S., Kokudo, N., Makuuchi, M. (2014). Above 5 cm, Size Doesn’t Matter Anymore in Patients with Hepatocellular Carcinoma. World Journal of Surgery, 38: 2910-2918.
[9]
Poon, D., Anderson, B. O., Chen, L. T., Tanaka, K. (2009). Asian Oncology Summit Management of Hepatocellular Carcinoma in Asia. Lancet oncololgy, 10 (11): 1111-1118.
[10]
Hwang, J., Kim, S. H., Lee, M. W. and Lee, J. Y. (2012) Small (< 2cm) hepatocellular carcinoma in patients with chronic liver disease: a comparison of gadoxetic acid-enhanced 3. 0 T MRI and multiphasic 64-multiraw detector CT. British Journal of Radiololgy, 85 (1-15): 314-322.
[11]
Noh, J. H., Kim, T. S., Ahn, K. S., Kim, Y. H. and Kang, K. J. (2016). Prognostic factors after hepatic resection for the single hepatocellular carcinoma larger than 5 cm. Annals of Surgical Treatment and Research, 91 (3): 104-111.
[12]
Zhao, H. C., Wu, R. L., Liu. F. B., Zhao, Y. J. (2016). A Retrospective Analysis of Long Term Outcomes in Patients Undergoing Hepatic Resection for Large (>5 cm) Hepatocellular Carcinoma. Hepatopancreatobiliary: 1-7.
[13]
Golsea, N., El Bouyousfib, A., Marques, F., Bancel, B., Mohkamb, K., Ducerf, C., Merle, P., Sebaghe, M., and Castaing, D. (2018). Large hepatocellular carcinoma: Does fibrosis really impact prognosis after resection? Journal of Visceral Surgery, 155: 265-273.
[14]
Cauchy, F., Soubrane, O., Belghiti, J. (2014). Liver resection for HCC: Patient's selection and controversial scenarios. Best Practice & Research Clinical Gastroenterology, 28: 881-889.
[15]
Tiffany, C. L., Tan, T. C., Kenneth, S. H., Albert, C. Y., Poon, R. T. (2014). Treatment Strategy to Improve Long-Term Survival for Hepatocellular Carcinoma Smaller than 5 cm: Major Hepatectomy vs Minor Hepatectomy. World Journal of Surgery, 38: 2386-2394.
[16]
Hokuto, D., Nomi, T., Yasuda, S., Yoshikawa, T., Yamada, T., (2018). Does anatomic resection improve the postoperative outcomes of solitary hepatocellular carcinomas located on the liver surface? Surgery, 163: 285–90.
[17]
Kluger, M. D., Salceda, J. A., Laurent, A., Tayar, C., Decaens, T., Cherqui, D. (2015). Liver resection for hepatocellular carcinoma in 313 Western patients: Tumor biology and underlying liver rather than tumor size drive prognosis. Journal of Hepatology, 62: 1131–1140.
[18]
Hwang, S., Lee, Y. J., Kim, K. H., Ahn, C. S., Moon, D. B., (2015). Long-Term Outcome after Resection of Huge Hepatocellular Carcinoma >10 cm: Single-Institution Experience with 471 Patients. World Journal of Surgery, 39: 2519-2528.
[19]
Goh, B. K., Teo, J. Y., Chan, C. Y., Lee, S. Y., Jeyaraj, P., Cheow, P. C., (2016). Importance of Tumor Size as a Prognostic Factor after Partial Liver Resection for Solitary Hepatocellular Carcinoma: Implications on the Current AJCC Staging System. Journal of Surgical Oncology, 113: 89–93.
[20]
Hwang, S., Lee, Y. J., Kim, K. H. (2015). The impact of tumor size on long-term survival outcomes after resection of solitary hepatocellular carcinoma: Single-institution experience with 2,558 patients. Journal of Gastrointestinal Surgery, 19: 1281-1290.
Browse journals by subject