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Resection of a Transplantable Single-Nodule Hepatocellular Carcinoma in Child-Pugh Class A Cirrhosis: Factors Affecting Survival and Recurrence

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Abstract

Background

The aim of this study was to estimate the survival rates and define risk factors for tumor recurrence after resection surgery for single hepatocellular carcinomas (HCCs) ≤5 cm (on preoperative imaging) that developed on compensated cirrhosis.

Methods

A retrospective review studied patients treated by surgical resection. Overall survival (OS), disease-free survival (DFS), recurrence rates, and risk factors were studied for all patients.

Results

A total of 49 patients were treated by resection. The 5-year OS and DFS rates were 52 and 41%, respectively, after 2000. Three independent risk factors were found for OS and DFS: macroscopic vascular invasion, satellite nodules, R1 resection. In the absence of these three factors, the 5-year OS was 59%. Recurrence rates were 63%. Delayed recurrence was significantly related to the 5-year OS. One factor was correlated with early recurrence: the presence of satellite nodules; and one factor was correlated with late recurrence: hepatitis C virus infection.

Conclusions

R0 resection for HCC on compensated cirrhosis may offer good long-term survival in the absence of satellites nodules and macrovascular invasion. Thus, a “first approach” resection is proposed with the possibility of “salvage transplantation.” In other cases, resection may be a bridge to transplantation (“transplantation de principe”).

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Author information

Author notes

  1. Fabrice Muscari

    Present address: Service de Chirurgie Digestive et Transplantation Hépatique, CHU Rangueil, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France

Authors and Affiliations

  1. Liver Transplantation and Digestive Surgery Unit, University Hospital of Rangueil, Toulouse, France

    Fabrice Muscari, Bertrand Foppa & Bertrand Suc

  2. Epidemiology and Inserm U1027 Laboratory, Toulouse, France

    Fabrice Muscari

  3. Digestive Surgery Unit, University Hospital of Purpan, Toulouse, France

    Nicolas Carrere

  4. Organ Transplantation and Nephrology Unit, University Hospital of Rangueil, Toulouse, France

    Nassim Kamar

  5. Hepatology Unit, University Hospital of Purpan, Toulouse, France

    Jean-Marie Peron

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  1. Fabrice Muscari
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  2. Bertrand Foppa
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Correspondence to Fabrice Muscari.

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Muscari, F., Foppa, B., Carrere, N. et al. Resection of a Transplantable Single-Nodule Hepatocellular Carcinoma in Child-Pugh Class A Cirrhosis: Factors Affecting Survival and Recurrence. World J Surg 35, 1055–1062 (2011). https://doi.org/10.1007/s00268-011-1000-3

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