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