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Role of Operative Therapy in Non-cirrhotic Patients with Metastatic Hepatocellular Carcinoma

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

We investigated the role of operative therapy in non-cirrhotic patients who developed metastatic hepatocellular carcinoma (HCC).

Methods

This retrospective cohort study included consecutive non-cirrhotic patients with metastatic HCC after a prior hepatectomy treated between 1990 and 2009. Patients were stratified by operative therapy (resection, ablation, transcatheter therapy). Kaplan–Meier analyses with log-rank comparisons tested effects of operative therapy on overall survival (OS) and progression-free survival (PFS).

Results

Of 195 non-cirrhotic patients treated for HCC during the study period, 98 [median age 65, interquartile range (IQR) 53–71; 55 % male] subsequently developed metastatic HCC (55 intrahepatic only). Median time to development of metastases after the index operation was 10 months (IQR 5–20 months); median number of metastases was 3 (IQR 2–7). Half of these patients (n = 50) underwent operative treatment of metastases; 20 (40 %) underwent metastasectomy, 18 (36 %) ablation, and 12 (24 %) transcatheter therapy. Operative therapy was associated with improved OS (p < 0.001). Resection or ablation was associated with improved PFS and OS compared to transcatheter therapy (all p ≤ 0.006). Nine patients (seven resection, two ablation) are disease free at a median of 50 months (IQR 24–80 months) posttreatment.

Conclusions

Resection and ablation are associated with an improved PFS and long-term OS and should be considered in select patients with metastatic HCC.

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Authors and Affiliations

  1. Division of Gastroenterologic and General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Victor Zaydfudim, Rory L. Smoot, Clancy J. Clark, Michael L. Kendrick, Florencia G. Que, Michael B. Farnell & David M. Nagorney

Authors
  1. Victor Zaydfudim
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  2. Rory L. Smoot
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  3. Clancy J. Clark
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  4. Michael L. Kendrick
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  5. Florencia G. Que
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  6. Michael B. Farnell
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  7. David M. Nagorney
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Corresponding author

Correspondence to David M. Nagorney.

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Zaydfudim, V., Smoot, R.L., Clark, C.J. et al. Role of Operative Therapy in Non-cirrhotic Patients with Metastatic Hepatocellular Carcinoma. J Gastrointest Surg 16, 1516–1523 (2012). https://doi.org/10.1007/s11605-012-1918-2

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  • DOI: https://doi.org/10.1007/s11605-012-1918-2

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