Abstract
BackgroundReports on the risk factors of peritoneal recurrence (PR) after liver resection for hepatocellular carcinoma are lacking. We examined the risk factors of PR after hepatectomy and the outcome of resected PR at our institution.MethodsWe retrospectively reviewed the data from 1,222 patients who underwent hepatectomies for hepatocellular carcinoma in Samsung Medical Center from January 2006 to August 2010. We identified patients with PR and studied the risk factors and outcomes of resected PR.ResultsThe rate of PR was 3.0% (n = 36). The mean ± SD age of patients was 54.0 ± 10.2 years. Among those with PR, 23 patients (63.9%) had unresectable disease and 13 patients (36.1%) had resectable disease. Multivariate analysis found that tumor size >50 mm, presence of microvascular invasion, bile duct invasion, and positive margins were significant risk factors of PR after liver resection. The median overall survival (OS) for resectable PR was 33.0 (28.0–61.6) months compared to 14.0 (6.8–21.2) months for unresectable PR (P = 0.009). Cox regression analysis demonstrated that resected PR [hazard ratio (HR) 0.042, P = 0.001] and interval between hepatectomy and PR (>6months) (HR 0.195, P = 0.016) were positive prognostic factors for OS, while alfa-fetoprotein >200 ng/dl at detection of PR (HR 11.321, P = 0.015) and serosal involvement of primary hepatocellular carcinoma (HR 25.616, P = 0.007) were negative prognostic factors for OS.ConclusionsWe found that tumor size >50 mm, presence of microvascular invasion, bile duct invasion, and positive resection margins were significant risk factors of PR after liver resection. Selected patients with resected PR had significantly better OS.
Highlights
Reports on the risk factors of peritoneal recurrence (PR) after liver resection for hepatocellular carcinoma are lacking
We found that tumor size[50 mm, presence of microvascular invasion, bile duct invasion, and positive resection margins were significant risk factors of PR after liver resection
By means of logistic regression, we found that tumor size [50 mm [odds ratio (OR) 1.368, P = 0.032], presence of microvascular invasion (MVI), bile duct invasion, and positive resection margins were significant predictors of PR after liver resection for Hepatocellular carcinoma (HCC) in this cohort (Table 3)
Summary
We performed retrospective data collection of all patients who underwent liver resection for HCC at Samsung Medical Center, South Korea, from January 2006 to September 2010. In the absence of other systemic metastasis or inoperable intrahepatic recurrences of HCC, if the peritoneal lesions were resectable and without compromising essential anatomic structures such as major vasculature, surgical resection would be offered to the patient. Resection of the peritoneal lesions was carefully performed to ensure adequate surgical margin. The interval from hepatectomy to PR was documented For those who developed unresectable PR (commonly as a result of concurrent systemic metastasis to other sites such as lung and bone, or unresectable intrahepatic recurrence), radiologic information on TABLE 1 Pattern of distribution of PR in the study cohort (n = 36). Male Female Cause of HCC Chronic hepatitis B Chronic hepatitis C Other (alcoholic liver disease, etc.) History of ruptured HCC Treatment before hepatectomy TACE RFA Both RFA and TACE Method of surgical access Open Laparoscopic Laparoscopic converted to open Types of hepatectomy Nonanatomic resection Anatomic resection Right hemihepatectomy Left hemihepatectomy Posterior sectionectomy Anterior sectionectomy Extended right hepatectomy Extended left hepatectomy Left lateral sectionectomy Anatomic monosegmentectomy Central hepatectomy Bisegmentectomy Subsegmentectomy Preoperative blood parameters Prehepatectomy AFP level, mean ± SD AFP B 400 ng/ml AFP [ 400 ng/ml Prehepatectomy PIVKA-II level, mean ± SD Size of HCC at hepatectomy, mm, median (range) Stratification of size of HCC Tumor B 50 mm Tumor [ 50 mm Edmonson grade I and II III and IV T stage of HCC T1 and T2 T3 and T4
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