Safety of liver resection for HCC in patients previously treated with sorafenib.

Abstract

345 Background: The efficiency of sorafenib in HCC has led to its utilization in the neo-adjuvant setting in selected cases. We assessed the safety of liver surgery in patients previously treated with sorafenib. Methods: From January 2009 to April 2010, 8 patients were resected following treatment with sorafenib. The median length of treatment was 1.5 months (range: 0.23-15). Mean size of tumors was 6.4cm (2-10). Alphafoetoprotein (AFP) was elevated in 5 patients, ranging from 45 to 100,000. Six patients had chronic liver disease. The cohort of 8 patients was cross-matched with 17 comparable patients who underwent primary resection without sorafenib during the same period. Results: After sorafenib therapy there was a decrease of HCC size (n=4, median size decrease of 55%) and AFP level (n=4). AFP returned to normal in 3 patients. Peri-operative data showed that previous treatment with sorafenib was not associated with increased length of surgical procedure (265 vs. 293 min), blood loss (400 vs. 530cc) or blood transfusion (0 vs. 5 Units). No mortality was reported, while overall morbidity (50 vs. 61%), length of stay (10 vs. 12 days) and intensive care requirement (43 vs. 44%) were similar in both groups. Recovery of postoperative liver biochemical tests did not show significant differences between the groups. Specimen analysis showed a higher rate of tumor necrosis in the sorafenib group (100% vs 46%) while no hepatotoxicity induced by chemotherapy was found. Conclusions: The administration of preoperative sorafenib therapy, which can improve disease control of HCC, does not increase operative risk. No significant financial relationships to disclose.