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Preoperative Predictors of Early Recurrence After Liver Resection for Multifocal Hepatocellular Carcinoma

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Liver transplantation remains the optimal treatment for multifocal hepatocellular carcinoma (HCC). However, due to resource constrains, other therapeutic modalities such as liver resection (LR), are frequently utilized. LR, however, has to be balanced against potential morbidity and mortality along with the risks of early recurrence leading to futile surgery. In this study, we evaluated preoperative factors, including inflammatory indices, in predicting early (< 1 year) recurrence in patients who underwent LR for multifocal HCC.

Methods

This was a post hoc analysis of 250 consecutive patients with multifocal HCC who underwent LR.

Results

After exclusion of 10 patients with 30-day/in-hospital mortality, 240 were included of which 134 (55.8%) developed early recurrence. Hepatitis B/C aetiology, 3/ > more hepatic nodules and elevated alpha-fetoprotein (AFP) ≥ 200 ng/ml were significant independent preoperative predictors of early recurrence. The early recurrence rate was 72.1% when 2 out of 3 significant predictive factors were present. The conglomerate of all 3 factors predicted early recurrence of 100% with a statistically significant association between number of predictive factors and early recurrence (p < 0.001).

Conclusion

Better patient selection via the use of preoperative predictive factors of early recurrence such as hepatitis B/C aetiology, ≥ 3 nodules and elevated AFP ≥ 200 ng/ml may assist in identifying patients in whom LR is deemed futile and improve resource allocation.

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Data Availability

Data available on request due to privacy/ethical restrictions.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Authors and Affiliations

  1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, 169856, Singapore, Singapore

    Yuxin Guo, Yun Le Linn, Ye Xin Koh, Ek Khoon Tan, Jin Yao Teo, Peng Chung Cheow, Prema Raj Jeyaraj, Pierce K. H. Chow, London L. P. J. Ooi, Alexander Y. F. Chung, Chung Yip Chan & Brian K. P. Goh

  2. Duke-National University of Singapore Medical School, Singapore, Singapore

    Yun Le Linn, Ye Xin Koh, Ek Khoon Tan, Jin Yao Teo, Peng Chung Cheow, Prema Raj Jeyaraj, Pierce K. H. Chow, London L. P. J. Ooi, Alexander Y. F. Chung, Chung Yip Chan & Brian K. P. Goh

  3. Liver Transplant Service, SingHealth Duke-National University of Singapore Transplant Centre, Singapore, Singapore

    Ye Xin Koh, Ek Khoon Tan, Peng Chung Cheow, Prema Raj Jeyaraj, Alexander Y. F. Chung, Chung Yip Chan & Brian K. P. Goh

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  1. Yuxin Guo
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Contributions

Yuxin Guo, Yun Le Linn and Brian KP Goh played a significant role in drafting of the study and authorship of the manuscript with Brian KP Goh being the overall supervisor of the study.

The other authors (Ye Xin Koh, Ek Khoon Tan, Jin Yao Teo, Peng Chung Cheow, Prema Raj Jeyaraj, Pierce KH Chow, London LPJ Ooi, Alexander YF Chung, Chung Yip Chan) have revised the manuscript and were accountable for the integrity of the work with approval of this version of the manuscript to be published.

Corresponding author

Correspondence to Brian K. P. Goh.

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Guo, Y., Linn, Y. ., Koh, Y.X. et al. Preoperative Predictors of Early Recurrence After Liver Resection for Multifocal Hepatocellular Carcinoma. J Gastrointest Surg 27, 1106–1112 (2023). https://doi.org/10.1007/s11605-023-05592-1

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