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Micronvasive behaviour of single small hepatocellular carcinoma: which treatment?

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Abstract

Background

Microinvasion (MI), defined as infiltration of the portal or hepatic vein or bile duct and intrahepatic metastasis are accurate indicators of a poor prognosis for mall hepatocellular carcinomas (HCC). A previous study showed that intraoperative ultrasound (IOUS) definition of MI-HCC had a high concordance with histological findings. Aim of this study is to evaluate overall survival and recurrence patterns of patients with MI-HCC submitted to hepatic resection (HR) or laparoscopic ablation therapies (LAT).

Methods

A total of 171 consecutive patients (78 h; 93 LAT) with single, small HCC (< 3 cm) with a MI pattern at IOUS examination were compared analyzing overall survival and recurrence patterns using univariate and multivariate analysis and weighting by propensity score.

Results

Overall recurrences were similar in the 2 groups (HR: 51 patients (65%); LAT: 66 patients (71%)). The rate of local tumor progression in the HR group was very low (5 pts; 6%) in comparison to LAT group (22 pts; 24%; p = 0.002). The overall survival curves of HR are significantly better than that of the LAT group (p = 0.0039). On the propensity score Cox model, overall mortality was predicted by the surgical treatment with a Hazard ratio 1.68 (1.08–2.623) (p = 0.022).

Conclusions

If technically feasible and in patients fit for surgery, HR with an adequate tumor margin should be preferred to LAT in patients with MI-HCC at IOUS evaluation, to eradicate MI features near the main nodule, which are relatively frequent even in small HCC (< 3 cm).

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Authors and Affiliations

  1. ASST Fatebenefratelli Sacco, Chirurgia Generale Ospedale Fatebenefratelli, Piazza Principessa Clotilde 3, 20121, Milano, Italy

    Roberto Santambrogio, Valentina D’Alessandro, Giulio Iacob & Marco Antonio Zappa

  2. Chirurgia Epato-Bilio-Pancreatica Ospedale San Paolo Università Di Milano, Milano, Italy

    Matteo Barabino & Enrico Opocher

  3. Anestesia E Rianimazione Ospedale Fatebenefratelli, Milano, Italy

    Marco Gemma

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  1. Roberto Santambrogio
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  4. Giulio Iacob
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  5. Enrico Opocher
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  7. Marco Antonio Zappa
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Contributions

RS acts as the submission's guarantor. Each author participated with substantial contributions to conception, analysis and interpretation of data, active participate in drafting and revising it, with a final approval for publication. RS: project development, data analysis & collection, interpretation of data, manuscript writing/editing. MB: project development, data analysis & collection, interpretation of data, manuscript editing. VD’A: data analysis & collection, manuscript editing. GI: data analysis & collection, manuscript editing. EO: project development, interpretation of data, manuscript editing. MG: project development, interpretation of data, manuscript writing/editing. MAZ: project development, interpretation of data, manuscript writing/editing.

Corresponding author

Correspondence to Roberto Santambrogio.

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Conflict of interest

All authors declare that they have no conflicts of interest or financial ties to disclose.

Ethics approval

This retrospective study protocol was approved by our Institutional Review Board and waived the requirement for informed consent.

Research involving human participants and/or animals Institutional review research board approval was granted by ASST Fatebenefratelli Sacco, and appropriate good clinical and research practices were followed.

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We have obtained consent to publish from the participants to report individual patient data.

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Santambrogio, R., Barabino, M., D’Alessandro, V. et al. Micronvasive behaviour of single small hepatocellular carcinoma: which treatment?. Updates Surg 73, 1359–1369 (2021). https://doi.org/10.1007/s13304-021-01036-0

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  • DOI: https://doi.org/10.1007/s13304-021-01036-0

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