Abstract
The clinico-pathological features and long-term results of 39 patients with resected small hepatocellular carcinoma (HCC) managed over 19 years in Hong Kong were retrospectively studied (mean diameter ± standard deviation: 3.6±1.3 cm). Thirty-one patients were symptomatic and the majority (n=33) of them had cirrhosis. When compared with 182 patients with large HCC operated within the same period, these patients with small HCC had a significantly higher incidence of spontaneously ruptured lesions (p<0.03). Following hepatic resection-major lobectomy (n=19) and limited hepatic resection (n=20), operative and hospital deaths occurred in 7.7% and 12.8% of patients, respectively. The size of the lesion had little influence on prognosis. The overall survival at 1, 3, and 5 years was 59%, 28%, and 11%, respectively, which was comparable to patients with large HCC ≥5 cm. Further stratification of these 39 patients according to a diameter of >3 cm (n=22) or ≤3 cm (n=17) showed no difference in long-term outcome. When compared with large tumors, frequent encapsulation (p<0.04) and less venous permeation (p <0.03) were encountered in small HCC. As the extent of hepatectomy had no effect on long-term outcome, limited hepatectomy for patients with small HCC is probably the procedure of choice. A 1 cm macroscopic resection margin is apparently adequate to ensure complete histological disease clearance.
Résumé
Les aspects pathologiques et cliniques ainsi que les résultats à long terme de 39 patients ayant un carcinome hépatocellulaire de petite taille traités à l'Hôpital Queen Mary à Hong Kong ont été analysés rétrospectivement (la petite taille étant définie comme diamètre <5 cm: diamètre moyen +/− écarttype=3.6 +/− 1.3 cm). Trente et un patients étaient symptomatiques alors que 33 étaient cirrhotiques. Ces patients avaient une incidence significativement plus élevée de rupture spontanée (p < 0.03) par rapport aux 182 autres patients atteints de carcinome hépatocellulaire de plus grande taille et opérés pendant la même période. Au plan chirurgical, il a été pratiqué 19 lobectomies majeures et 20 résections plus limitées. Le taux de mortalité, per ou périopératoire, était de 7.7 et 12.8%, respectivement, pour chaque type de résection. La taille des lésions avait peu d'influence sur le pronostic. La survie globale à 1, 3 et 5 ans était de 59%, 28% et 11%, respectivement, tout à fait comparable à ceux des patients ayant un carcinome hépatocellulaire de plus de 5 cm. Lorsque l'on comparait les résultats selon que le diamètre de la tumeur était > 3 cm (n = 22) ou < ou = à 3 cm (n=17), il n'y avait pas de différence staistiquement significative à long terme. Comparés aux tumeurs plus volumineuses, les carcinomes de diamètre < 5 cm étaient plus souvent encapsulés (p<0.04) et indemnes de perméation veineuse (p<0.03). Comme il n'y avait aucune différence de survie selon l'étendue de la résection, l'hépatectomie limitée est probablement la technique de choix dans les carcinomes hépatocellulaires de petite taille. Une marge macroscopique de 1 cm semble être suffisante pour assurer l'exérèse complète des lésions microscopiques.
Resumen
Se estudiaron retrospectivamente las características clínicopatológicas y los resultados a largo término de 39 pacientes con carcinomas hepatocelulares (CHC) pequeños (diámetro promedio ± desviación stándar: 3.6±1.3 cm) manejados en Hong Kong en un período de 19 años; 31 pacientes eran asintomáticos y la mayoría (n=33) de ellos tenía cirrosis. Al compararlos con los 182 pacientes con grandes CHC operados en el mismo período, se encontró que estos pacientes exhibían una tasa significativamente mayor de rotura espontánea de las lesiones (p<0.03). Después de la resección hepática-lobectomiía mayor (n=19) y la resección hepática limitada (n=20), se présentó mortalidad operatoria y hospitalaria en 7.7% y 12.8% respectivamente. El volumen de la lesión exhibió escasa influencia sobre el pronóstico. La sobrevida global a 1, 3 y 5 años fue de 59%, 28% y 11% respectivamente, tasas comparables con las de los pacientes con CHC ≥ 5 cm. Al subdividir estos 39 casos entre los que tenían tumores con diámetros >3 cm (n=22) o≤3 cm (n=17) no se halló diferencia en el resultado a largo plazo. En comparación con los tumores grandes, en los CHC pequeños se encontró encapsulación frecuente (p<0.04) y menos invasión venosa (p<0.03). Puesto que la amplitud de la hepatectomía no produce diferencia en el resultado a largo plazo, la hepatectomía limitada parece ser el procedimiento de escogencia en paciente con CHC pequeños. La provisión de un margen de 1 cm aparece adecuada para asegurar la resección con márgenes histológicamente libres.
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Lai, E.C.S., Ng, I.O.L., You, K.T. et al. Hepatic resection for small hepatocellular carcinoma: The queen mary hospital experience. World J. Surg. 15, 654–659 (1991). https://doi.org/10.1007/BF01789219
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DOI: https://doi.org/10.1007/BF01789219